Monday report

Rx coverage

Monday report

David Ermer–CDC, CMS, FDA, Generative AI, Medical / Rx research, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • The Hill reports,
    • “The Trump administration on Monday proposed stripping the power of an independent board to review challenges from fired federal workers while barring employees from taking the matter to court.
    • “The new proposed rule would impact federal workers fired through a Reduction in Force (RIF), the process used at 22 different agencies last year as the Trump administration conducted widespread layoffs.
    • “If finalized, any federal worker fired in a future RIF would not be able to plead their case before the quasi-judicial Merit Systems Protection Board (MSPB), which last year found that some agencies had “engaged in a prohibited personnel practice” in firing the workers. 
    • “Instead, any challenges would be reviewed by the Office of Personnel Management (OPM), which last year alongside the Office of Management and Budget instructed agencies to begin RIFs.”
  • Per a CMS news release,
    • “Today, the Centers for Medicare & Medicaid Services (CMS) proposed regulations to lower health care costs, promote competition, and strengthen program integrity in the Federal and State-Based Health Insurance (Exchanges). The proposed Notice of Benefit and Payment Parameters for 2027 would crack down on fraud and misleading practices by agents and brokers, restore accountability for taxpayer-funded subsidies, and remove federal barriers that have limited plan innovation and driven up premiums—helping ensure coverage is more affordable and works better for consumers, taxpayers, and states.” * * *
    • “To review the proposed rule, visit https://www.federalregister.gov/d/2026-02769. 
    • “Public comments must be submitted by March 11, 2026. 
    • “To review the proposed rule fact sheet, visit https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule.” 
  • Bloomberg Law adds,
    • “The Notice of Benefit and Payment Parameters from the Centers for Medicare & Medicaid Services would allow certain plans that offer preset dollar amounts for care—such as indemnity plans—to meet the requirements of a “qualified health plan” under the ACA if they demonstrate a sufficient number of doctors would accept the plan’s payment terms.” * * *
    • “The rule likewise expands hardship exemptions to permit more individuals to buy “catastrophic” plans with the lowest level of cost-sharing and coverage, and allows catastrophic plan issuers to offer multi-year terms. The proposal would also permit plans with low deductibles and higher out-of-pocket costs
    • “The rule also reverses changes made under the Biden administration, including requiring insurers to offer standardized plan options that were meant to simplify choices.”
  • Healio observes,
    • “A voluntary program designed to help Medicare Part D beneficiaries manage drug costs[, which took effect last year,] could provide considerable benefit to people with cancer, according to study results.
    • “The Medicare Prescription Payment Plan (M3P) provides flexibility that may ease financial distress — particularly for those with limited or fixed incomes — and reduce the potential for cost-related treatment nonadherence, researchers concluded.”
    • “However, many patients and health care professionals are unaware of the program, according to Aryana Sepassi, PharmD, MAS, assistant professor of clinical pharmacy at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.”

From the Food and Drug Administration front,

  • MedTech Dive reports,
    • “The Food and Drug Administration’s breakthrough program has made a steady start to the 2026 financial year, granting designations at the same pace as in the two prior years.
    • “After years of growth that peaked in 2021, designations have settled at a lower rate in recent years. The agency awarded 164 to 166 designations per financial year three times from 2022 to 2025.
    • “The FDA is on course to grant a similar number of breakthrough designations in its 2026 financial year. After one quarter, the agency had awarded 42 designations, a pace that would result in 168 breakthrough statuses if maintained across the full financial year.”
  • MedPage Today tells us,
    • “Oncology specialists should inform patients about a risk of serious toxicity related to dihydropyrimidine dehydrogenase (DPD) deficiency and should test for DPYD variants before starting treatment with capecitabine (Xeloda) and fluorouracil, the FDA announced.
    • “In a safety update communicationopens in a new tab or window, the agency noted that DPYD encodes DPD, which breaks down more than 80% of fluorouracil. Certain homozygous or compound heterozygous DPYD variants result in complete or near-complete absence of DPD activity, increasing the risk for serious, potentially fatal toxicities when exposed to capecitabine or fluorouracil, which are widely used in cancer treatment. Potential adverse reactions include mucositis, diarrhea, neutropenia, and neurotoxicity. The reactions also can occur in patients who have partial DPD activity.
    • “Capecitabine and fluorouracil, or 5-FU, are routinely used in treatment regimens for breast, colorectal, gastric, and pancreatic cancers.”
  • STAT New informs us,
    • “The Food and Drug Administration has rejected a rare-disease gene therapy from Regenxbio, the company said Monday. 
    • “The one-time treatment, called RGX-121, is designed to replace a malfunctioning gene that causes mucopolysaccharidosis type II, also known as Hunter syndrome, an ultra-rare disorder that causes physical and cognitive impairments.”
    • “Regenxbio had applied for accelerated approval, a type of conditional market clearance, based on RGX-121’s ability to significantly reduce in the short term a specific biomarker in cerebrospinal fluid believed to correlate with longer-term cognitive improvements in patients with the severe form of Hunter syndrome. 
    • “But the FDA, in its letter rejecting the therapy, raised questions about the appropriateness of using the surrogate biomarker, called CSF HS D2S6, as a predictor of clinical benefit. The agency also questioned the eligibility criteria  Regenxbio used to enroll patients into its clinical trial and the use of a natural history comparator arm, the company said.”  

From the judicial front,

  • Bloomberg Law reports,
    • “Medical providers are testing a new legal strategy to recoup unpaid arbitration awards as health insurers rack up victories in surprise billing disputes.
    • “The shift underscores the difficulties both sides face in arbitration under the No Surprises Act, which requires doctors and insurers to settle most unexpected out-of-network bills themselves rather than balance-billing the patient. The volume of disputes has exposed cracks in the system, leading to a series of lawsuits around ineligible claims, fraud, and unpaid awards.
    • “Courts have largely concluded that the law doesn’t grant doctors the right to sue over unpaid awards in most circumstances. Most recently, the US Supreme Court denied two air ambulance companies’ petition to hear their case after the US Court of Appeals for the Fifth Circuit ruled against them.
    • “Providers are now adapting their legal strategy by arguing insurance companies are guilty of improper denial of benefits under the Employee Retirement Income Security Act and unjust enrichment under common law. Hundreds of cases in the US District Court for the District of New Jersey were paused last month pending a decision on the amended claims in Rowe Plastic Surgery of NJ LLC v. Aetna Life Insurance Co .
    • “But the doctors are likely to face problems, at least in overcoming ERISA preemption on their unjust enrichment claims, said Leslie Howard, co-founder of Cohen Howard, a firm representing out-of-network providers.”
  • The American Hospital Association News relates,
    • “The 5th U.S. Circuit Court of Appeals Feb. 9 affirmed a district court ruling upholding Louisiana’s 340B contract pharmacy law. The state law prohibits drug companies from denying hospitals the same 340B discounts for drugs dispensed at community pharmacies that would be provided via in-house pharmacies. Three drug companies — AbbVie, PhRMA and AstraZeneca — challenged the law, arguing that it was unconstitutional in several ways. “Rejecting those arguments, the appeals court held that Louisiana’s law was not preempted by federal law, did not violate the Fifth Amendment’s Takings Clause, did not violate the Constitution’s Contract Clause and was not unconstitutionally vague. “States regulate pharmacies — and the distribution of drugs to those pharmacies — every day,” the 5th Circuit explained. “Act 358 fits comfortably within that tradition.
    • “The AHA filed friend-of-the-court briefs supporting Louisiana’s law last year.” 
  • The Society for Human Resource Management notes,
    • “On Feb. 6, a federal appeals court vacated a preliminary injunction of two executive orders (EO) — EO 14151 on “Ending Radical and Wasteful Government DEI Programs and Preferencing” and EO 14173 on “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” — finding they were not unconstitutional on their face. The court had previously stayed the injunction, pending appeal. This ruling was the first by a federal appeals court to find the two EOs facially constitutional. Both EOs focused on infrastructure inside the federal government with an emphasis on contracts and grants.
    • “EO 14173, issued Jan. 21, 2025, “was the most significant EO for the private sector” last year, said W. John Lee, an attorney with Morgan Lewis in Philadelphia. Established on May 19, 2025, the U.S. Department of Justice’s Civil Rights Fraud Initiative “is a direct result of the EO and is a prominent example of how it is reshaping federal enforcement of civil rights law.” EO 14151, issued Jan. 20, 2025, set the tone for EO 14173. EO 14173 reshaped compliance obligations for federal contractors and grantees. It also revoked EO 11246, ending EO-based affirmative action programs for women and minorities.
    • “On Jan. 21, 2025, U.S. Equal Employment Opportunity Commission (EEOC) Chair Andrea Lucas made it clear that the EEOC’s enforcement priorities had shifted in alignment with President Donald Trump’s EOs.
    • “While the 4th U.S. Circuit Court of Appeals vacated the injunction, it sent the case back to the district court for further proceedings and left open the possibility of challenges based on individual application of the EOs.”
  • The Wall Street Journal points out,
    • “A lawsuit that drugmaker Novo Nordisk filed on Monday against telehealth firm Hims & Hers shows how fierce the maneuvering over the booming obesity-drug market has become.
    • “In the lawsuit filed in a federal court in Delaware, Novo Nordisk accused Hims & Hersof violating the patents covering its Ozempic and Wegovy drugs used for weight loss by trying to sell custom-made versions of those medicines.
    • “The pill from Hims & Hers threatened to undermine Novo Nordisk’s efforts to recapture momentum in the $70 billion weight-loss drug market by providing a lower-cost alternative to a Wegovy pill the Danish company recently launched.
    • “Novo Nordisk has been pulling out the stops to reclaim the momentum it lost to Eli Lilly in the booming market.” 

From the public health and medical / Rx research front,

  • Health Day tells us,
    • “Americans could be facing an uphill battle when it comes to protecting their heart health as they age, a new Cleveland Clinic poll reveals.
    • “Nearly 3 of 4 Americans (72%) feel confident in their ability to maintain heart health as they age, the survey found.
    • “But nearly as many (69%) also report that they have at least one known risk factor for heart disease.
    • “Worse, nearly 1 in 4 (24%) aren’t sure whether they are at increased risk for heart disease, according to the survey.
    • “Healthy aging is about prevention,” said Dr. Samir Kapadia, chair of cardiovascular medicine at the Cleveland Clinic.
    • “Heart disease often develops silently over decades, which is why staying active, understanding your risk factors, and addressing them early can make a profound difference in both quality of life and longevity,” Kapadia said in a news release.”
  • The American Medical Association lets us know “what doctors wish patients knew about the shingles virus.”
    • “If you’ve ever had chickenpox, then the virus that causes shingles is present in your body and can resurface at some point in the future. Find out more.”
  • The New York Times relates,
    • “If you think your daily doses of espresso or Earl Grey sharpen your mind, you just might be right, new science suggests.
    • “A large new study provides evidence of cognitive benefits from coffee and tea — if it’s caffeinated and consumed in moderation: two to three cups of coffee or one to two cups of tea daily.
    • “People who drank that amount for decades had lower chances of developing dementia than people who drank little or no caffeine, the researchers reported. They followed 131,821 participants for up to 43 years.
    • “This is a very large, rigorous study conducted long term among men and women that shows that drinking two or three cups of coffee per day is associated with reduced risk of dementia,” said Aladdin Shadyab, an associate professor of public health and medicine at the University of California, San Diego, who wasn’t involved in the study.”
  • NBC News relates,
    • “Bad,” or LDL, cholesterol is a major risk factor for heart disease and most people are screened for it as part of their yearly physicals.
    • There’s another marker in the blood that may be a better predictor of heart disease risk, a recent large review suggests. But it’s not part of routine blood testing.
    • “Apolipoprotein B (apoB) is a protein that attaches to harmful fat particles in the blood. The apoB protein is found on the surface of harmful lipoproteins like low density lipoprotein, or LDL, that contribute to heart disease. Since each one of the harmful particles contains one apoB molecule, testing for it essentially captures the overall number of harmful plaque-producing compounds.” * * *
    • “ApoB testing is hot among health influencers and increasingly touted in the commercial blood testing market. Recently, the Sweetgreen salad chain — which has tied itself to anti-seed-oil influencers — launched a collaboration with the testing company Function Health and is promoting apoB screening along with its menus.
    • “Dr. Michael Shapiro, a preventive cardiologist and the chair of the American Heart Association Council on Lipidology, Lipoprotein, Metabolism & Thrombosis, said that he typically uses an apoB test in select patients.” * * *
    • “In some cases, insurance may cover the test. If not, it typically costs around $70 at a lab.
    • “There aren’t clear guidelines for what target apoB levels should be. In healthy people, apoB values less than 90 mg/dL are typically considered acceptable, with some saying lower targets closer to 70 mg/dL may be more optimal for preventing heart disease.”
  • MedPage calls attention to
    • “Most women said they preferred clinic-based cervical cancer testing over at-home self-sampling, with demographics and life experiences shaping those preferences, a cross-sectional study indicated.
    • “In a nationally representative survey, 20.4% of women said they would prefer to do their own at-home self-sampling for cervical cancer screening, while 60.8% said they prefer clinic-based testing and 18.8% said they were uncertain on their preference, reported Sanjay Shete, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues in JAMA.
    • “The survey showed that women who had experienced prejudice or discrimination while receiving medical care had higher odds of preferring self-sampling at home (adjusted OR 1.94, 95% CI 1.16-3.22), while Black women had lower odds of preferring at-home self-sampling compared with their white peers (aOR 0.45, 95% CI 0.21-0.96).
    • “When women were asked why they preferred at-home self-sampling, privacy was the most common reason (54.9%), followed by time constraints (35.1%) and fear of embarrassment (33.4%).”
  • and
    • “The CDC’s Advisory Committee on Immunization Practices recently voted to stop recommending a universal dose of the hepatitis B vaccine at birth.
    • “An evidence review found that universal hepatitis B vaccination at birth is safe, effective, and protective for individual and public health.
    • “There was no improvement in safety or effectiveness with a delayed first dose of the hepatitis B vaccine.”
  • Per Genetic Engineering and Biotechnology News,
    • “In a study using gut microbiome samples from over 11,000 people across 39 countries, a single group of bacteria (CAG-170) has been found in higher numbers in the gut microbiomes of healthy people. CAG-170 remain unculturable in the lab, and are only identifiable from their genetic fingerprints.
    • “Further analysis of CAG-170 revealed the bacteria have the capacity to produce high levels of Vitamin B12 and enzymes that break down a wide range of carbohydrates, sugars, and fibers in our gut. The researchers suggest that Vitamin B12 supports other species of gut bacteria, rather than supporting the humans whose guts it is being produced in. CAG-170 could, in the future, be used as an indicator of our gut microbiome health or serve as the basis for the development of probiotics specifically designed to support and maintain healthy levels of CAG‑170 in the gut.”
  • Per Cardiovascular Business,
    • “An oral PCSK9 inhibitor from Merck is associated with significant reductions in low-density lipoprotein (LDL) cholesterol, according to new data published in The New England Journal of Medicine.[1] All PCSK9 inhibitors on the market today are injectable—an oral option that does not require needles could make a major impact on patient care. 
    • “Fewer than half of patients with established atherosclerotic cardiovascular disease currently reach LDL cholesterol goals,” lead author Ann Marie Navar, MD, PhD, an associate professor of cardiology at the University of Texas Southwestern Medical Center in Dallas, said in a statement. “An oral therapy this effective has the potential to dramatically improve our ability to prevent heart attacks and strokes on a population level.”
    • “Back in November, researchers presented initial findings from this study at the American Heart Association’s Scientific Sessions 2025 conference. Now, however, the analysis can be read in full.
    • “The CORALreef Lipids trial focused on nearly 3,000 heart patients with high LDL cholesterol who were randomized to either receive enlicitide, Merck’s experimental oral PCSK9 inhibitor, or a placebo. Two patients received the new drug for every one patient treated with a placebo.”
  • Per Radiology Business,
    • “A new MRI-specific artificial intelligence tool could significantly improve the diagnosis of neurological conditions in busy settings. 
    • “Developed by researchers at the University of Michigan, the tool can read brain scans in just seconds. The tool, named Prima, is a video language model that can simultaneously process video, images and text in real time. Experts involved in its development are hopeful it can help address the rising imaging volumes.
    • “As the global demand for MRI rises and places significant strain on our physicians and health systems, our AI model has potential to reduce burden by improving diagnosis and treatment with fast, accurate information,” said senior study author Todd Hollon, MD, a neurosurgeon at U-M Health. 
    • “Researchers trained Prima using more than 200,000 MRI exams collected at the university over several decades. Imaging data were included alongside patients’ medical histories and clinical indications for the scans. The team tested the model on more than 30,000 brain studies over a one-year period. Unlike earlier AI tools that focus on just one disease, Prima was designed to analyze all available imaging and clinical information at once, similar to how a radiologist reviews a case, giving it broad applicability.” 

From the U.S. healthcare business front,

  • Healthcare Dive reports,
    • “Kaiser Permanente nearly tripled its operating income last year, even as the integrated healthcare conglomerate weathered rising expenses.
    • “Kaiser, which recorded results alongside its subsidiary Risant Health, recorded operating income of $1.4 billion last year, up from $569 million in 2024 as the nonprofit continued to invest in operational improvements, according to earnings results released last week. 
    • “Still, expenses rose by more than $11 billion last year as Kaiser said rising medication costs and other line items made providing care more expensive.”
  • Beckers Hospital Reviews identifies eleven rapidly growing health systems.
  • BioPharma Dive relates,
    • “Eli Lilly will acquire biotechnology startup Orna Therapeutics, saying Monday it will pay up to $2.4 billion to buy the privately owned company and a technology able to reprogram immune cells within the body.
    • “The Indiana-based drugmaker didn’t disclose how much upfront cash it’s shelling out for Orna, which specializes in “circular” RNA medicines that are believed to be more stable and easier to pair with the lipid nanoparticles used for delivery. But it noted in its statement that it intends to use Orna’s technology to develop cell therapies for autoimmune conditions.
    • “In announcing the deal, Lilly cited its interest in Orna’s lead project, which instructs immune cells to latch onto B cells that are attacking patients’ tissue in inflammatory diseases. The company presented data from preclinical studies at the American Society for Hematologymeeting in December that it’s using to support advancing into Phase 1 studies.”
  • and
    • “Japan’s largest drug company is teaming up with an artificial intelligence specialist to find new medicines for cancer and other diseases, through a deal that could be worth more than $1.7 billion.
    • “Announced Monday, the multiyear collaboration grants Takeda Pharmaceutical access to two technologies at Iambic Therapeutics. The first is an AI-driven platform used to discover and develop new drugs. The second is a model meant to predict how proteins will interact with certain receptors.
    • “The companies haven’t disclosed the deal’s upfront cost, nor any specific disease targets. The focus, though, will be on small molecule drugs for cancers and conditions rooted in the digestive or immune systems. Iambic will get milestone payments based on the partnership’s level of success, and is also eligible to receive royalties on net sales of any products it generates.”
  • Per Beckers Payer Issues,
    • “Patients who take advantage of zero-cost preventive screenings see better health outcomes and reduced spending, according to January research from BCBS Association and Blue Health Intelligence.
    • “The groups reviewed claims data of BCBS members with breast or colorectal cancer. The research pointed to lower likelihood of invasive tests and treatment.
    • “Eighty-one percent of members who were diagnosed with colorectal cancer through a preventive screening were classified in an early stage, compared to a 73% rate overall. For breast cancer, that figure was 86% during preventive screening. The early-stage rate was 82% overall.” 
  • Per an Institute of Clinical and Economic Review news release,
    • “The Institute for Clinical and Economic Review (ICER) today posted its revised Evidence Report assessing the comparative clinical effectiveness and value of sibeprenlimab (Voyxact®, Otsuka Holdings Co., Ltd.), atacicept (Vera Therapeutics, Inc.), and delayed-release budesonide (“Nefecon”, Tarpeyo®, Calliditas Therapeutics AB) for IgA nephropathy.
    • “IgA nephropathy has historically been thought of as a relatively benign form of kidney disease, but it has become increasingly recognized that it frequently progresses to end-stage kidney disease,” said ICER’s Chief Medical Officer, David Rind, MD. “Management of progressive disease has typically included treatments targeted at B-cells, but such therapies, such as systemic glucocorticoids, have serious side effects. New therapies offer the possibility of better outcomes with fewer harms.”
    • “This Evidence Report will be reviewed at a virtual public meeting of the CTAF on February 26, 2026. The CTAF is one of ICER’s three independent evidence appraisal committees comprising medical evidence experts, practicing clinicians, methodologists, and leaders in patient engagement and advocacy.
    • “Register here to watch the live webcast of the virtual meeting.”

Weekend update

David Ermer–CDC, Congress, FDA, Medical / Rx research, Medicare, Mental health care, Rx coverage, U.S. Healthcare–

Happy Super Bowl Sunday!

  • The House Energy Commerce Committee health subcommittee holds a hearing on February 11 with Pharma and PBM executives.
  • Fierce Healthcare adds,
    • “In the $1.2 trillion budget package signed Tuesday, a little-known healthcare provision was reauthorized that will allow millions of people on Medicare to access diabetes prevention education online. 
    • “As part of the budget package, Congress passed the PREVENT DIABETES Act, which extends the ability for digital health companies (virtual suppliers) to participate in the Medicare Diabetes Prevention Program (MDPP) through the end of 2029. 
    • “Medicare Part B patients who are at risk for Type 2 diabetes can participate in the program for free, if they meet certain clinical thresholds for weight, blood pressure or blood glucose. The program lasts for a year and consists of 22 sessions on lifestyle changes to prevent diabetes. 
    • “Since the COVID-19 pandemic, virtual providers like Omada Health, 9am Health and Amwell have entered the business on temporary authority, much like other Medicare telehealth services.” 
  • Under the budget package, the Homeland Security appropriations bill remains under a continuing resolution which expires on February 13.
  • Roll Call lets us know,
    • “With no signs of tangible progress in negotiations over changes to immigration enforcement policies, the main question may be whether House members and senators can muster the votes needed for another short-term funding extension just for DHS.
    • “Both chambers of Congress are expected to be on recess next week for Presidents Day. The holiday weekend overlaps with the annual Munich Security Conference, which runs Feb. 13-15 and typically attracts a large congressional delegation.
    • “Senate Majority Leader John Thune, R-S.D., who is not traveling to Munich this week, suggested the Senate may need to be in session if the Homeland Security funding is not resolved.”

From the Food and Drug Administration front,

  • Healthcare Dive reports,
    • “Hims & Hers has abandoned plans to sell a compounded version of Novo Nordisk’s weight loss pill following backlash from U.S. regulators and the threat of a federal investigation. 
    • “In a short statement posted on the social media platform X Saturday, Hims said that, after “constructive conversations with stakeholders across the industry,” it “decided to stop offering access” to the treatment. “We remain committed to the millions of Americans who depend on us for access to safe, affordable, and personalized care.” 
    • “The sudden turn quickly ends, for now, plans by the telehealth company to launch a copycat form of Novo’s “Wegovy” pill. Hims had announced those plans on Thursday and, in doing so, quickly drew legal threats from Novo as well as swift action from the Food and Drug Administration.” 

From the public health and medical / Rx research front,

  • Clinical Advisor reports,
    • “Measles is now extending beyond families with young children, with outbreaks reported on college campuses and communities across the country.
    • “At least 12 people have tested positive for measles at Ave Maria University in Florida, near Naples, since January 29, according to local officials. Three people were taken to the hospital.
    • “A student at the University of Wisconsin-Madison also tested positive after traveling overseas.
    • “Earlier this year, Clemson University in South Carolina confirmed a measles case linked to someone with ties to the school.
    • “It takes only 3 cases of measles for health officials to declare an outbreak.
    • “So far in 2026, at least 17 states have reported infections, according to the US Centers for Disease Control and Prevention (CDC).”
  • CNN tells us,
    • “We often discuss depression and dementia separately, although scientists have long observed a connection between the two: People with depression appear to have a higher likelihood of developing dementia later in life.
    • “A new study published in The Lancet Psychiatry adds an important twistin untangling that relationship and looks beyond depression as a single diagnosis. By focusing on specific symptoms, the research raises a more precise and potentially more useful question: Could certain symptoms in midlife signal greater vulnerability to dementia decades later? And if so, what should people and clinicians do with that information now?”
    • The CNN reporter interviews CNN wellness expert Dr. Leana Wen about the study.
  • Medscape informs us,
    • “As GLP-1s continue to surge in demand, older patients in your practice may inquire about these medications for their weight-loss efforts. Although they are known to improve conditions such as high cholesterol and obesity and help with the management of type 2 diabetes, certain precautions should be considered for patients older than 65 years.
    • “Older adults often do their own research on wellness trends. If they ask about GLP-1 medications, knowing clinical and science-based facts can keep them informed and safe. Some experts say these medications and this patient population should be carefully considered.
    • “[In the article,] Yuval Pinto, MD, DABOM, assistant professor of medicine and part of the Healthful Eating, Activity & Weight Program at Johns Hopkins School of Medicine in Baltimore, laid out some of the risks.”

From the U.S. healthcare business front,

  • The Wall Street Journal reports,
    • “Two years ago, a GLP-1 prescription could cost an uninsured patient more than $1,000 a month. Today, Novo Nordisk’s NOVO.B Wegovy pill starts at just $149 through cash-pay programs. 
    • “In the world of Big Pharma, this is unheard of. 
    • “Typically, drug prices climb or plateau until generics arrive years later. That trend should be even stickier in a duopoly. Yet the obesity market has turned traditional pharma economics upside down. As Leerink analyst David Risinger notes, there isn’t a comparable precedent for this level of price erosion in the industry’s history.” * * *
    • The question both companies [Novo and Lilly] are now racing to answer is just how elastic consumer demand is in the obesity market. Lower prices are clearly unlocking growth in demand, especially in the cash-pay market. As Novo Nordisk Chief Financial Officer Karsten Munk Knudsen argued in an interview this week, this isn’t a price war, so much as a search for the price points that open the floodgates of access.
  • The New York Times lets us know “How to Tell if You Will Save Money Using TrumpRx.”
    • “People may be able to pay less for prescriptions with their insurance rather than via the new government website. The Trump drugstore is meant to help people buy medications using their own money.”
  • Beckers Payer Issues notes,
    • “Elevance Health bid on 11 national accounts in competing Blue Cross Blue Shield markets last year and won nine of them, the company said on its 2025 earnings call with investors, offering the first look at how a landmark antitrust settlement is reshaping competition within the Blues ecosystem.
    • “This is the first year that we’ve had the opportunity for employers in competing geographies against us who could actually quote with our organization if they wanted,” Morgan Kendrick, Elevance’s president of commercial and specialty health benefits, said Jan. 28.
    • “The provision, known as the “second blue bid,” stems from a $2.67 billion settlement that resolved allegations dating back to 2012 that BCBS companies conspired to divide up markets and avoid competing with one another, thereby driving up costs for consumers. Among other changes, the settlement struck down a rule that required large employers to work with the BCBS insurer covering the geography where the employer is headquartered.
    • “Now, for certain large national accounts, employers can solicit bids from any BCBS plan in the country, not just the one licensed in their service area. Elevance’s 9-for-11 record is the first concrete data point on how the settlement is reshaping competition among Blues plans, but industry observers say the effects could stretch beyond one selling season.
    • “Ari Gottlieb, a consultant to insurers and owner of A2 Strategy, told Becker’s the provision will primarily benefit BCBS plans with the existing scale and technology to compete nationally.”

Friday report

David Ermer–CDC, Congress, COVID-19, FDA, Generative AI, Rx coverage, U.S. Healthcare–

From Washington, DC

  • The Wall Street Journal reports,
    • “Mehmet Oz arrived on Capitol Hill last week to pitch Republicans on an idea to codify into law President Trump’s drug-pricing model, which ties U.S. pharmaceutical costs to lower prices typically paid abroad.
    • “Oz, the Centers for Medicare and Medicaid Services administrator, could sense the skepticism from GOP senators—members of the Finance Committee—as they raised concerns about industry backlash and a potential chilling effect on innovation.
    • “You read the room,” Oz said in an interview. “When’s the right time to tell them they need to do something different?”
    • “The move marked the opening effort of the administration’s push to advance the president’s planahead of the midterm elections, as healthcare costs have become a top voter concern. While Trump has proposed sending money directly to Americans through Health Savings Accounts to ease those costs, that discussion was absent from Oz’s talks with Republicans, he said.
    • “That’s not the most important issue for us,” said Oz, the former television host and celebrity surgeon widely known as Dr. Oz. He emphasized making sure that pricing deals reached under Trump with more than a dozen pharmaceutical companies endure beyond his time in office.”
  • and
    • “The White House on Thursday launched its drug-pricing website, dubbed TrumpRx, the culmination of efforts by the administration to bring down pharmaceutical costs for some consumers.
    • “When it launched, it had roughly 40 drugs available, including obesity treatments Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound and infertility treatments such as Gonal-F from EMD Serono. The prices for the drugs on TrumpRx were generally much lower than their sticker price, with President Trump touting some discounts of hundreds of dollars a month. The website, TrumpRx.gov, allows customers to search for specific medicines and purchase them through a manufacturer’s direct-to-consumer site, or in some cases gives users coupons that they can present at certain pharmacies.” * * *
    • “The website likely won’t have a substantial impact on the amount most Americans pay for their prescriptions, as most of Americans are insured—either through private or government plans—and are likely to get a better deal on the drugs via their coverage. The roughly 27 million Americans who are uninsured are those most likely to benefit from the direct-to-consumer offerings.” 
  • Here is a link to the White House’s fact sheet on TrumpRx.
  • Govexec tells us,
    • “The U.S. Postal Service on Thursday reported that it experienced a net loss of nearly $1.3 billion in the first quarter of fiscal 2026, as there continues to be a lack of consensus among postal leaders, stakeholders and lawmakers about how to fix the agency’s longstanding financial challenges. 
    • “Officials attributed the loss to a $634 million increase to workers’ compensation, among other spending hikes, paired with a $264 million reduction in operating revenue. In comparison, USPS saw a net income of $144 million during the first quarter of fiscal 2025. 
    • “USPS, however, experienced a net loss of $9 billion in fiscal 2025, and officials have projected that the postal agency will continue to operate in the red for fiscal 2026. 
    • “At a USPS Board of Governors meeting on Thursday, Postmaster General David Steiner and the board reiterated their argument that legislative and administrative reforms, such as raising the postal agency’s $15 billion statutory debt limit, are necessary to reverse these losses.”

From the Food and Drug Administration front,

  • Fierce Pharma reports,
    • “With online health and wellness company Hims & Hers opening a new front in the GLP-1 compounding showdown Thursday, the United States’ top drug regulator has taken notice.
    • “FDA will take swift action against companies mass-marketing illegal copycat drugs, claiming they are similar to FDA-approved products,” FDA commissioner Marty Makary, M.D., said in a Feb. 5 post on X. “The FDA cannot verify the quality, safety, or effectiveness of non-approved drugs.”
    • “Makary’s comments mark a clear and sharp rebuttal to Hims’ announcement earlier in the day that it had launched a compounded version of Novo Nordisk’s new Wegovy (semaglutide) pill for obesity, which starts at just $49 per month.”
  • and
    • “The FDA removed a prior “limitations of use” restriction it had placed on Gilead Sciences’ CAR-T Yescarta, allowing it to be used in patients with relapsed or refractory (R/R) primary central nervous system lymphoma (PCNSL).
    • “Yescarta is approved for R/R large B-cell lymphoma, but previously wasn’t permitted to treat those with the rare, fast-growing PCNSL subtype. Prognoses related to this disease, which originates in the brain, spinal cord, eye, or cerebrospinal fluid, are typically poor, with a five-year survival rate of about 30%. The cancer type has no standard-of-care treatment options and an estimated 1,500 cases are diagnosed annually in the U.S.
    • “Dana-Farber Cancer Institute ran a phase 1 study to evaluate the safety of Yescarta in patients with PCNSL, as those with the disease had previously been excluded from the clinical trials supporting Yescarta’s initial approval, global head of development at Gilead’s Kite unit, Gallia Levy, M.D., Ph.D. explained in a company release.” 
  • MedTech Dive relates,
    • “Johnson & Johnson is recalling certain Cerepak detachable coil systems due to a higher-than-expected failure to detach rate that has been associated with four serious injuries and one death. The events were reported as of Oct. 14.
    • “The failure to detach could result in hemorrhagic and ischemic stroke, procedural delays or the need for additional surgical intervention, according to the Food and Drug Administration, which posted the recall on Thursday.
    • “J&J issued a letter to customers on Oct. 2 recommending they remove certain Cerepak products from where they are used or sold.”
  • Cardiovascular Business tells us,
    • “Zydus Pharmaceuticals, a New Jersey-based distributor of generic drugs, has recalled nearly 23,000 bottles of its icosapent ethyl capsules due to leakage issues that may have weakened their effectiveness. The prescription-strength capsules were manufactured by Softgel Healthcare in India and are sold in the United States as a more affordable option to name-brand treatment options.
    • “Icosapent ethyl is primarily used to help treat patients with high triglyceride levels in their blood. Taken together with a statin, it can also help significantly reduce the risk of heart attack, stroke or other cardiac complications in certain patient populations.
    • “Use of the affected product may lead to inconsistent therapeutic effects and an increase in potential gastrointestinal side effects in some patients,” according to the Food and Drug Administration (FDA).”

From the judicial front,

  • Fierce Healthcare reports,
    • “The Department of Health and Human Services has officially backed down on its halted 340B Rebate Model Pilot Program, telling the courts this week that it plans to pull relevant notices and application approvals.
    • “Lawyers for the government and plaintiffs who sued to block the program—several hospitals and hospital groups including American Hospital Association (AHA)—filed Thursday afternoon in the U.S. District Court for the District of Maine a joint motion for vacatur and remand. 
    • “The filing acknowledged the preliminary injunction plaintiffs had secured and the government’s failed bid to have the the temporary pause overturned by the appellate court. Both reflected judges’ belief that the hospitals were likely to succeed on the merits of their claims based on at least two administrative issues—”a failure to provide a reasonable explanation or address significant reliance interests and a failure to consider relevant costs.” 
    • “As such, HHS does not believe providing more administrative documents to the court would change any decisions, according to the joint motion.”
  • The Wall Street Journal relates,
    • “Luigi Mangione will face murder and weapons charges in a Manhattan court in June for the killing of UnitedHealthcare CEO Brian Thompson, three months before jury selection in his federal trial for crimes related to the same killing.
    • “New York state court Judge Gregory Carro set a June 8 trial date during a snap hearing Friday, prompting an outburst from Mangione, who claimed he was being denied double-jeopardy protections.” * * *
    • “The Manhattan district attorney’s office argued the state case should go first because the killing occurred in Manhattan and local prosecutors—working with many NYPD detectives—led the investigation that resulted in Mangione’s arrest.
    • “The State has an overriding interest in trying this defendant for the cold-blooded execution of Brian Thompson on December 4, 2024. It resulted in the tragic death of a guest to our city on our streets,” Assistant District Attorney Joel Seidemann said in a letter to the judge.”

From the public health and medical / Rx research front,

  • The Centers for Disease Control and Prevention announced today,
    • “Seasonal influenza activity remains elevated nationally with most areas of the country reporting stable or decreasing trends. Emergency department visits are stable and highest among children 5-17 years. Hospitalizations trends continue to decrease overall and are highest among those 65 years and older. RSV activity is elevated in many areas of the country. Emergency department visits for RSV are highest among infants under 1 year and children 1-4 years old. RSV hospitalizations are highest among infants less than 1 year old.
    • “COVID-19
      • COVID-19 activity is elevated in some areas of the country.
    • “Influenza
      • “Seasonal influenza activity remains elevated nationally with most areas of the country reporting stable or decreasing trends; however, activity continues to increase in the Pacific Northwest.
      • “Additional information about current influenza activity can be found at: Weekly U.S. Influenza Surveillance Report | CDC
    • “RSV
      • RSV activity is elevated in many areas of the country, including emergency department visits among infants under 1 year and children 1-4 years old. Hospitalizations are highest among infants less than 1 year old.
    • “Vaccination
      • “National vaccination coverage for COVID-19, influenza, and RSV vaccines remains low for children and adults. COVID-19, influenza, and RSV vaccines can provide protection against severe disease this season. It is not too late to get vaccinated this season. Talk to your doctor or trusted healthcare provider about what vaccines are recommended for you and your family.
  • The University of Minnesota CIDRAP adds,
    • “The effectiveness of this season’s flu vaccine in Canada is 40% against medically attended infection with influenza A(H3N2) viruses, 37% against newly emerged and predominant subclade K of the H3N2 strain, and 31% against the H1N1 influenza A strain, an interim analysis estimates.
    • “Researchers from the Canadian Sentinel Practitioner Surveillance Network (SPSN) conducted the test-negative study, which evaluated samples from patients aged one year or older who had acute respiratory illness. Community-based sentinel health care providers in Alberta, British Columbia, Ontario, and Quebec collected the specimens from October 26, 2025, to January 10, 2026, and the findings were published yesterday in Eurosurveillance.”
  • The AP reports,
    • “During the early years of the COVID-19 pandemic, experts worried that disruptions to cancer diagnosis and treatment would cost lives. A new study suggests they were right.
    • “The federally funded study published Thursday by the medical journal JAMA Oncology is being called the first to assess the effects of pandemic-related disruptions on the short-term survival of cancer patients.
    • “Researchers found that people diagnosed with cancer in 2020 and 2021 had worse short-term survival than those diagnosed between 2015 and 2019. That was true across a range of cancers, and whether they were diagnosed at a late or early stage.
    • “Of course, COVID-19 itself was especially dangerous to patients already weakened by cancer, but the researchers worked to filter out deaths mainly attributed to the coronavirus, so they could see if other factors played a role.”
  • Healio informs us,
    • “As the number of home hazards increased, so did the effect of visual function on the odds of falling.
    • “Home safety evaluations and environmental adaptations could be helpful for adults with low vision.”
  • and
    • “Use of SGLT2 inhibitors was associated with lower 5-year risk for chronic kidney disease and AKI compared with GLP-1 receptor agonists for adults with type 2 diabetes, according to data published in JAMA Internal Medicine.”
  • Radiology Business lets us know;
    • “New research suggests that photon-counting computed tomography scans outshine conventional contrasted chest CT for follow-up imaging of lung cancer. 
    • “Patients who have been diagnosed with the disease require routine imaging to monitor treatment effectiveness and ensure their cancer has not progressed or recurred. This is typically done via standard contrast-enhanced CT scans. Though effective, the standard of care comes with caveats, including increased exposure to both radiation and contrast media. What’s more, image quality can vary based on patient size, which can negatively affect lesion detection and characterization. 
    • “Experts believe that emerging photon-counting technology can help address these shortcomings. Published in RSNA’s flagship journal, Radiology, a new paper details numerous benefits photon-counting CT scans have over conventional CTs, including reduced radiation exposure and enhanced lesion visualization. Experts involved in the study went as far as to suggest that the advanced technology could replace conventional CTs in certain settings soon.”
  • Genetic Engineering and Biotechnology News observes,
    • “If you zoomed in far enough on a new experimental HIV vaccine, you wouldn’t see the usual protein shell that most vaccines rely on. Instead, you’d find tiny geometric structures folded from strands of DNA—molecular origami designed not to be noticed at all. This “invisible” scaffold may be the key to awakening some of the rarest and most sought‑after cells in immunology: the B cells capable of maturing into broadly neutralizing antibody producers.
    • “Many next‑generation vaccines use virus‑like particles (VLPs)—nanostructures that mimic the outer shape of a virus but contain no genetic material. By displaying many copies of a viral antigen on their surface, VLPs can activate B cells far more effectively than free‑floating proteins. The paper is titled “DNA origami vaccines program antigen-focused germinal centers,” and was published recently in Science. 

From the U.S. healthcare business and artificial intelligence front,

  • Fierce Healthcare reports,
    • “Centene is “laser-focused” on improving the performance of its Medicaid business following a difficult 2025.
    • “CEO Sarah London told investors Friday morning on the company’s earnings call that the team made headway in this effort in later part of 2025, with it’s Q4 medical loss ratio of 93% on par with expectations set for analysts in October and showing notable improvement from the second quarter of 2025.
    • “She said that utilization trend patterns seen in the third quarter largely carried into Q4, with behavioral health as the largest driver. Home health services and high-cost pharmaceuticals were also key factors in cost and utilization trends seen in the back half of the year, she said.
    • “And while a spike in flu and other respiratory illnesses generated headlines late in the year, London said that utilization patterns in its Medicaid population were on par with expectations.
    • “As an organization, we have been laser-focused on restoring our Medicaid business to sustainable profitability while maintaining our focus on quality outcomes for our members and the communities we serve,” London said.”
  • and
    • “Molina Healthcare’s share price plunged on Friday as it posted a $160 million loss in the fourth quarter as well as guidance for 2026 that fell short of analysts’ expectations.
    • “Shares in the company were down by about 28% at 11:30 a.m. ET, with its stock tumbling out of the gate at market open on Friday. By comparison, Molina earned $251 million in profit for the fourth quarter of 2024.
    • “For the full year, Molina has posted $472 million in profit, down from $1.2 billion in 2024.
    • “In the earnings report, Molina revealed that it will exit the Part D space in the 2027 plan year due to financial pressure, including Medicare Advantage prescription drug (MAPD) plans. The company will focus on its existing dual-eligible business in Medicare, according to the announcement.”
  • Healthcare Dive relates
    • “Primary care physicians spend a significant amount of time on work in their electronic health records, even when they decrease the number of appointments they schedule with patients, according to new research published in Health Affairs.
    • “Physicians who cut back appointments saw their visit volume decline by 32.6% compared with other doctors. But their EHR time fell by just 21.2% — meaning the number of minutes spent in their records systems actually increased per visit by more than 20%, according to the study. 
    • ‘Primary care physicians need to handle a lot of tasks outside appointments, like responding to patient messages, researchers wrote. So reducing visits doesn’t necessarily eliminate a host of EHR tasks — though it does have repercussions for physicians’ pay and patients’ access to care, they noted.” 
  • and
    • “Epic rolled out an artificial intelligence tool this week that drafts clinical notes, setting up the nation’s largest electronic health record vendor as a major competitor in the ambient scribe market. 
    • “AI Charting, part of Epic’s AI tool called Art geared toward clinicians, listens during patients’ appointments with providers and can suggest orders based on the conversation. The product also allows clinicians to personalize the note’s structure using voice commands, like asking the tool to format current conditions as a bulleted list, according to a press release. 
    • “Epic plans to expand beyond documentation to make the tool “an active assistant in the room,” Corey Miller, Epic’s vice president of research and development, said via email. “This is really just the start for Art,” he said.”
  • Fierce Healthcare adds,
    • “Infinitus has launched a new suite of agentic artificial intelligence tools for healthcare payers that aim to improve member engagement through personalized communications.
    • “Infinitus is an AI company that helps call centers better handle inbound call volumes. For payer organizations, pressured to control costs as call volumes rise and ratings of members demand a modern consumer experience, AI is positioned to solve both issues. 
    • “With the Agentic AI Member Services Suite, health plan members have 24/7 access to an AI agent that can answer simple administrative questions, onboard members, triage questions and navigate care. Through messaging and calling capabilities, Inifinitus’ AI agents can proactively reach out to patients and scale member services without adding team members.”
  • and
    • “Aetna is continuing to build out its digital member experience with the launch of a new onboarding program designed to ease the process.
    • “The insurer said Thursday that the platform will be available to 4 million new members during the welcome period for their enrollment. The program leads on Rich Communication Services, or RCS, to support navigation and connect members with key information and resources they may need after enrolling in a new plan through text messaging.
    • “Nathan Frank, senior vice president and chief digital and technology officer for Aetna, told Fierce Healthcare that building trust with the member requires an end-to-end experience, and tech like the new onboarding program can play a key role in that effort.
    • “Onboarding isn’t just about administration and signing people up and making sure that you have the right information,” he said. “It’s the moment when members decide whether their health plan feels simple, or is it overwhelming?” 

Thursday report

David Ermer–Congress, FDA, Federal employment benefits, Generative AI, Medical / Rx research, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC

  • Govexec reports,
    • “The House Oversight and Reform Committee on Wednesday unanimously advanced legislation aimed at updating the federal government’s buyout programs to encourage employees to leave.
    • “Voluntary Separation Incentive Payments are one of the government’s main tools for reducing agency headcounts, alongside Voluntary Early Retirement Authority and reductions in force. But VSIP offerings max out at $25,000, where the cap has sat since the 1990s.
    • “The Federal Workforce Early Separation Incentives Act (H.R. 7256), introduced by Rep. Nick Langworthy, R-N.Y., would remove the $25,000 hard cap on VSIP payments and replace it with a maximum of six months of a federal worker’s salary, subject to agency head approval. The new model is based off how federal agencies already calculate severance pay for laid-off feds.
    • ‘Langworthy said an update to the federal government’s buyout program was long-overdue, and that the changes will allow agencies to move more agilely—and humanely—in workforce planning.”
  • The Wall Street Journal relates,
    • “The Trump administration is planning to make it easier to discipline—and potentially fire—career officials in senior positions across the government, a move that would affect roughly 50,000 federal workers. 
    • “The U.S. Office of Personnel Management, which oversees the federal workforce, issued a final rule on Thursday that creates a category of worker for high-ranking career employees whose work focuses on executing the administration’s policies. Workers who fall into that category would no longer be subject to rules that for decades have set a high bar for firing federal employees.
    • “While political appointees at agencies are considered at-will employees who serve at the discretion of the president, career employees have long enjoyed strong job protections, including the ability to appeal firings, suspensions, or disciplinary action to an independent board. Workers that fall under the new category wouldn’t be able to appeal to the board.”
  • An OPM news release adds,
    • “The final rule was published for public inspection in the Federal Register on February 5, 2026, and will take effect 30 days after publication. Following the rule’s effective date, specific positions may be placed in Schedule Policy/Career by presidential executive order. Read Director Kupor’s blog post on the rule here.”
  • Tammy Flanagan, writing in Govexec, points out “the federal leave options employees can use when annual and sick time run out.”
    • “From unpaid leave to parental and military leave, federal workers have multiple options for time off under specific circumstances.”
  • STAT News informs us,
    • “President Trump on Thursday night is planning to announce the launch of TrumpRx, the website that he and his aides have touted for months as a platform aimed at lowering prescription drug prices. 
    • “The website, which uses technology from health care company GoodRx, is expected to display the cash prices — that is, the prices available when paying without insurance — for certain drugs and direct patients to other sites where they can buy the therapies. It’s part of Trump’s plan to lower drug prices in the U.S., but some experts are skeptical the platform will meaningfully affect affordability.” * * *
    • “TrumpRx will not sell medications. It is expected to be a searchable website that links to other sites through which patients can directly buy brand drugs. That might be a drug company’s own website, such as Eli Lilly’s LillyDirect or Novo Nordisk’s NovoCare Pharmacy, or an online pharmacy that partners with a drugmaker, such as Amazon Pharmacy and Truepill.”
  • The American Hospital Association News notes,
    • “The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology announced the selection of nine pilots as part of the Behavioral Health Information Technology Initiative to help improve behavioral health data exchange across care settings. The BHIT Initiative is a $20 million effort led by ASTP/ONC in coordination with the Substance Abuse and Mental Health Services Administration to support standard data elements and foster data exchange. The pilots, which will be completed by the end of this year, will be used to inform future standards, technical specifications, guidance and policy considerations. The pilots span across 45 exchange partners and eight states and Washington, D.C. The states are Colorado, Connecticut, Delaware, Florida, Massachusetts, North Carolina, Oregon and Rhode Island.”
  • Healthcare Dive calls our attention to the fact
    • “More than one-fourth of doctors enrolled in Medicaid didn’t actually deliver care to any Medicaid beneficiaries in 2021, according to new research adding to worries about low physician participation in the safety-net insurance program.
    • “Almost 28% of doctors enrolled in Medicaid were “ghost providers” and didn’t treat a single patient that year, the study published in Health Affairs on Monday found. Another 10% treated fewer than 10 patients, while the remaining 62.2% were standard or “core” providers treating the brunt of Medicaid enrollees.
    • “Participation varied widely by specialty, with psychiatrists most likely to be ghost providers and primary care physicians and cardiologists least likely to be ghost providers, the study found.”

From the Food and Drug Administration front,

  • STAT News reports,
    • “The nation’s top drug regulator said he wants to do away with pharmaceutical ads that employ “dancing patients, glowing smiles, and catchy jingles that drown out the fine print.” On Super Bowl Sunday, the drug industry will treat him to lounging football stars, a shouting DJ Khaled, and the soothing tones of Enya.
    • “Sunday’s game, the annual zenith of American advertising, is the first since Food and Drug Administration Commissioner Marty Makary began a self-described “crackdown” on drug marketing last year. And, based on the ads released in advance, little has changed in the eyes of the industry.” 
  • Per an FDA news release,
    • “Today, the U.S. Food and Drug Administration took additional steps to support the transition of our nation’s food supply from the use of artificial petroleum-based colors to alternatives derived from natural sources. Companies will now have flexibility to claim products contain ‘no artificial colors’ when the products do not contain petroleum-based colors. In the past, companies were generally only able to make such claims when their products had no added color whatsoever — whether derived from natural sources or otherwise.
    • “The agency sent a letter to industry providing notice of the FDA’s intent to exercise enforcement discretion related to these voluntary labeling claims.”

From the public health and medical / Rx research front,

  • The AP reports,
    • “Chronic exposure to pollution from wildfires has been linked to tens of thousands of deaths annually in the United States, according to a new study. 
    • “The paper, published Wednesday in the journal Science Advances, found that from 2006 to 2020, long-term exposure to tiny particulates from wildfire smoke contributed to an average of 24,100 deaths a year in the lower 48 states.
    • “Our message is: Wildfire smoke is very dangerous. It is an increasing threat to human health,” said Yaguang Wei, a study author and assistant professor in the department of environmental medicine at Icahn School of Medicine at Mount Sinai. 
    • “Other scientists who have studied the death toll from wildfire smoke were not surprised by the findings. 
    • “The estimates they’re coming up with are reasonable,” said Michael Jerrett, professor of environmental health science at the University of California, Los Angeles who was not involved in the study. “We need more of them. It’s only if we’re doing multiple studies with many different designs that we gain scientific confidence of our outcomes.”
  • Bloomberg Law tells us,
    • “Chris Womack is one of a dwindling number of Texas ranchers who can remember fighting the New World screwworm, a once-vanquished pest threatening to make an unwanted encore in the US after its recent return to northern Mexico. 
    • “You never forget the smell,” Womack, 60, said of his first encounter with a calf being devoured by screwworm maggots. It was one of many he and his father would treat in the early 1970s as an outbreak of the parasite — which can kill cattle in less than two weeks — devastated Texas ranchers.
    • “More than 50 years later, Womack and other Texas cattlemen are bracing for the screwworm’s potential comeback. Cases are proliferating in a Mexican state that borders Texas, with the pest having escaped containment by an international eradication program that banished it for decades. Texas Governor Greg Abbott issued a disaster declaration last week to open up state resources for the screwworm response.
    • “The pest’s resurgence would squeeze the $130 billion US cattle industry, which is already struggling with a record-low herd and rising costs. The screwworm prompted the US to ban cattle imports from Mexico for much of the last 14 months, crimping American beef producers at a time when record prices for the meat are adding to the pressure on shoppers angry about the cost of food.”
  • MedPage Today lets us know,
    • “New research challenged the longstanding belief that autism is much more common in males versus females.
    • “In a Swedish study of 2.7 million people, male-to-female ratios in autism diagnoses were nearly equal by age 20.
    • “Diagnosis rates peaked earlier for males, but females experienced a significant catch-up in adolescence.”
  • Genetic Engineering and BioTechnology News relates,
    • “Some types of CD8+ T cells (killer T cells) may play a role in the development of multiple sclerosis (MS). This is according to data from a new study published in Nature Immunology. Specifically, scientists found specific T cells that are abundant in people with MS, which also target the Epstein-Barr virus (EBV). They suggest that this points to a possible role for the virus in triggering the immune response seen in the autoimmune disease.   
    • “Full details are published in a paper titled “Antigen specificity of clonally enriched CD8+ T cells in multiple sclerosis.” For Joe Sabatino, MD, PhD, senior author on the study and an assistant professor of neurology at University of California, San Francisco’s Weill Institute for Neurosciences, “these understudied CD8+ T cells [connect] a lot of different dots.” That is because scientists have known for several years that EBV, a common virus carried by about 95 percent of adults, is present in virtually everyone who develops MS. This data “gives us a new window on how EBV is likely contributing to this disease,” he said.” 
  • Per BioPharma Dive,
    • “Bayer’s experimental blood thinner asundexian cut the relative likelihood of a repeat stroke by 26% without increasing the risk of internal bleeding, the company said Thursday, boosting hopes that the company might become a new option for “secondary treatment” of the disorder.
    • “The news could also elevate the outlook for medicines like asundexian, which are called Factor XIa inhibitors and are being advanced by a handful of the world’s largest pharmaceutical companies.
    • “Members of that drug class, including asundexian and a similar therapy from Bristol Myers Squibb and Johnson & Johnson, have previously suffered clinical setbacks in different types of cardiovascular illnesses. But asundexian’s success, first announced in November, lifted Bayer shares and indicated the drugs might be able to fulfill at least some of their commercial potential.
    • “The German drugmaker released full data from its positive study, “Oceanic-Stroke,” at the International Stroke Conference in New Orleans on Thursday.” 
  • Per the AP,
    • “A new kind of pill sharply reduced artery-clogging cholesterol in people who remain at high risk of heart attacks despite taking statins, researchers reported Wednesday.
    • “It’s still experimental but the pill helps rid the body of cholesterol in a way that today can be done only with injected medicines. If approved by the Food and Drug Administration, the pill, named enlicitide, could offer an easier-to-use option for millions of people.
    • “Statins block some of the liver’s production of cholesterol and are the cornerstone of treatment. But even taking the highest doses, many people need additional help lowering their LDL, or “bad,” cholesterol enough to meet medical guidelines.
    • “In a major study, more than 2,900 high-risk patients were randomly assigned to add a daily enlicitide pill or a dummy drug to their standard treatment. The enlicitide users saw their LDL cholesterol drop by as much as 60% over six months, researchers reported in the New England Journal of Medicine.”

From the U.S. healthcare business and artificial intelligence front,

  • Healthcare Dive reports,
    • “Cigna posted fourth quarter 2025 results Thursday morning that outperformed analysts’ consensus expectations, with adjusted revenue of $72.5 billion up more than 10% and adjusted operational income of $2.1 billion up 16%.
    • “Cigna Healthcare, the company’s insurance division, saw its revenue drop 16% in the quarter due to the sale of its Medicare Advantage business to Health Care Service Corporation. Cigna Healthcare’s operational income rose 44% year over year, however, after the company jacked up premiums for its stop-loss products after seeing those costs spike in the fourth quarter of 2024.
    • “But the lion’s share of attention on Thursday morning’s call was devoted to Express Scripts, and how the FTC settlement might impact the massive PBM’s profits.
    • “Short answer? It won’t, executives said.”
  • BioPharma Dive relates
    • “Hims & Hers Health is launching a copycat form of Novo Nordisk’s newly launched obesity pill, ushering in the latest contentious battle between the makers of branded weight loss medications and their drug-compounding counterparts. 
    • “Hims said Thursday that it’s now enabling healthcare providers to prescribe a compounded pill with the same active ingredient, semaglutide, as Novo Nordisk’s oral Wegovy. That treatment will be sold as part of treatment plans that begin at $49 for the first month — $100 lower than the price Novo is charging under a deal with the Trump administration. Hims also claimed that its treatment is formulated differently and involves a different delivery method to protect the active ingredient during digestion. 
    • “In a statement issued in response to Hims’ announcement, Novo spokesperson Ambre James-Brown called Hims’ move “illegal mass compounding and deceptive advertising” and threatened litigation. The compounder is “unlawfully” mass-marketing an “unapproved, inauthentic, and untested knockoff” of Novo’s medication, she said.” 
  • Modern Healthcare tells us,
    • “Adtalem Global Education has become Covista, the Chicago-based education company said, with a plan to expand its healthcare career network.
    • “Covista serves nearly 100,000 students and has a community of 385,000 alumni across its five accredited institutions.
    • “Covista touts it puts 24,000 new professionals annually into the healthcare workforce — more than any other U.S. institution — including 10% of America’s new nurses.”
  • Beckers Payer Issues lets us know,
    • “Participating Medicare Part D plans can officially begin covering weight-loss treatment in 2027. 
    • “The initiative falls under CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The December news followed President Trump’s negotiations with Eli Lilly and Novo Nordisk to secure most-favored-nation pricing for drugs that treat obesity, diabetes and related conditions.
    • “To better understand Medicare usage and spending shifts, KFF analyzed CMS data from 2019 through 2024 [as discussed in the article].
  • and
    • “Here are 12 payer tools that achieved “Best in KLAS” recognition for 2026:
      • “Care management solutions: Cognizant (TriZetto CareAdvance Enterprise) 
      • “Claims & administration platforms: Cognizant (TriZetto Core Claims/Administration Solutions)
      • “CMS payer interoperability: Edifecs (XEngine Server for FHIR)
      • “Data analytics platforms: Innovaccer (Healthcare Data Platform)
      • “Payer/provider data exchange: Moxe (Digital ROI)
      • “Post-payment accuracy & integrity solutions: Trend Health Partners (TRENDConnect) 
      • “Pre-payment accuracy & integrity solutions: HealthEdge (Source)
      • ‘Quality measurement & reporting: Inovalon (Converged Quality) 
      • “Risk adjustment (coding, retrieval & compliance solutions): Datavant (Risk Adjustment Suite)
      • “Risk adjustment (POC & in-home health assessments): Cozeva (PayerOne Risk)
      • “IT consulting services: Huron
      • “Employer-sponsored healthcare services: Premise Health
    • “The full report is accessible from KLAS Research here.“
  • Per Beckers Hospital Review,
    • “Chicago-based CommonSpirit Health now has 242 artificial intelligence applications live across its hospitals, up from 230 last year.
    • “We are expanding our use of AI across CommonSpirit by deploying new capabilities and scaling the most impactful of our existing tools,” CIO Daniel Barchi told Becker’s.
    • “In 2025, the health system generated more than $100 million in annual savings through its use of AI and robotic process automation tools across multiple areas of the organization. Mr. Barchi said the value generated in fiscal year 2026 is expected to exceed last year’s total.
    • “More important than the financial impact is the expanded clinical and operational value we are seeing from these tools — value that is not measured only in dollars,” he said. “Our sepsis surveillance tool has contributed to continued reductions in sepsis-related mortality. Screening tools for colon and breast cancer are helping us identify high-risk patients, leading to thousands of additional screenings. AI tools for imaging are reducing scan times by up to 50%, supporting a better experience for patients and providers.”
    • “As CommonSpirit expands its AI footprint, Mr. Barchi said the health system has also declined or scaled back AI tools that failed to deliver expected value.”

Monday report

David Ermer–CDC, CMS, Congress, FDA, Generative AI, Medical / Rx research, Mental health care, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • The Hill reports,
    • “GOP lawmakers returning to Capitol Hill are facing a health care bind, with Affordable Care Act (ACA) subsidies having expired Dec. 31, and no clear path forward for extending them.
    • “The GOP remains split over whether to extend the subsidies at all. But last month, four Republican centrists, frustrated with party leadership, joined Democrats in backing a discharge petition on legislation to extend the subsidies for three years.
    • “Speaker Mike Johnson (R-La.) told reporters in December he plans to bringthe bill to the floor this week, according to CBS News. It is expected to pass and head to the Senate, where it will likely undergo bipartisan reform to get the necessary 60 votes to advance. 
    • “I think a straight-up extension is a waste of money,” Senate Majority Leader John Thune (R-S.D.) said before the recess. “But if there are reforms and both sides sit down and agree on what that looks like and then there’s a transition that gives people the option of putting money into a [health savings account] … then there could be a path forward.”
  • MedCity News tells us,
    • “According to one expert at Pitchbook, two core issues are likely to dominate healthcare reform discussions in 2026: rising costs and flaws in Medicare Advantage.
    • “Healthcare affordability remains a major systemic issue preventing millions of Americans from accessing care, and Medicare Advantage’s risk-adjustment system is “clearly broken,” creating incentives that pull excess money into the program, explained Brian Wright, lead analyst for healthcare research at Pitchbook.
    • “On the Affordable Care Act and commercial market side of things, reforms will probably aim to improve affordability and risk pooling, he said. With Medicaid eligibility pressures pushing providers to shift costs to commercial payers, Wright suggested that lawmakers may look for ways to make the commercial market function more effectively rather than serve as the system’s subsidizer.”
  • Politico adds,
    • “After a bruising clash last year, funding the government for the remainder of this fiscal year could prove to be the least contentious issue, if today offers any indication. In a bicameral breakthrough, top appropriators this morning released the text of the three-bill funding package to pass ahead of the Jan. 30 shutdown deadline, POLITICO’s Jennifer Scholtes and Meredith Lee Hill report. As GOP leaders start to whip votes, they’re planning to put the package to a vote in the House on Thursday.”
  • The Wall Street Journal points out,
    • “Democrats are increasingly wary of another government shutdown after a 43-day government-funding lapse last year.
    • “A shutdown last year backed by Democrats to force funding for enhanced Affordable Care Act coverage didn’t succeed.
    • “The Congressional Budget Office estimates that extending enhanced ACA benefits for three years would add $83 billion to the federal deficit.”
  • Per an HHS news release,
    • “Deputy Secretary of Health and Human Services Jim O’Neill, in his role as Acting Director of the Centers for Disease Control and Prevention (CDC), today signed a decision memorandum* [PDF, 894 KB] accepting recommendations from a comprehensive scientific assessment [PDF, 1.05 MB] of U.S. childhood immunization practices, following a directive from President Trump to review international best practices from peer, developed countries.”
  • A related HHS fact sheet explains
    • The updated CDC childhood immunization schedule:
      • Recommends all vaccines for which there is consensus among peer nations.
      • Allows for more flexibility and choice, with less coercion, by reassigning non-consensus vaccines to certain high-risk groups or populations and shared clinical decision-making.
      • Ensures that all the diseases covered by the previous immunization schedule will still be available to anyone who wants them through Affordable Care Act insurance plans and federal insurance programs, including Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children program. Families will not have to purchase them out of pocket. Among peer nations, the U.S. will continue to offer the most childhood vaccines for free to those who want them.
      • Is accompanied by a strengthening of vaccine research through HHS’ commitment to double-blind placebo controlled randomized trials as well as more observational studies to evaluate long-term effects of individual vaccines and the vaccine schedule.

From the Food and Drug Administration front,

  • BioPharma Dive reports,
    • “Moderna has filed approval applications for a seasonal flu vaccine it expects to become a critical source of future revenue growth.
    • “The company on Monday said it submitted clearance requests with regulators in the U.S., Europe, Canada and Australia. Moderna is specifically seeking approvals to market the vaccine, dubbed mRNA-1010, for people at least 50 years of age. 
    • “If approved, this potential new product launch and geographic expansion represent an important opportunity to support Moderna’s continued growth in 2027 and beyond,” said Moderna CEO Stéphane Bancel, in a statement.” 
  • Beckers Hospital Review adds,
    • “Axsome Therapeutics received FDA acceptance and priority review designation for its supplemental new drug application for AXS-05, a treatment for agitation associated with Alzheimer’s disease.
    • “The FDA set a Prescription Drug User Fee Act action date of April 30, 2026. AXS-05 is a combination of dextromethorphan hydrobromide and bupropion hydrochloride.
    • “Agitation affects up to 76% of individuals with Alzheimer’s disease, and there are currently few approved treatment options, according to a Dec. 31 news release. The application is supported by data from four randomized, double-blind, controlled phase 3 trials and a long-term safety study.”
  • Fierce Pharma recounts the FDA’s new drug approvals issued in 2025.
    • “There were 46 novel drug approvals in 2025, compared to 55 in 2023 and 50 in 2024. Meanwhile, the FDA’s Center for Biologics Evaluation and Research endorsed 18 new biological treatments in 2025, compared to 25 in 2023 and 18 in 2024.
    • “The surge in December included seven novel approvals, which was the most in any month of 2025. There also were many more novel approvals (30) in the second half of 2025 than in the first half (16), indicating that the U.S. regulator functioned more efficiently as it gained stability through the year.”

From the judicial front,

  • Bloomberg Law offers more details on the Human Rights Campaign’s complaint filed against OPM with the EEOC.
    • Four federal employees represented by the Human Rights Campaign filed a class action discrimination claim against the Trump administration over its near-total ban on gender-affirming care in federal health plans.
    • The notice filed Jan. 1 with the Office of Personnel Management initiates legal proceedings with an Equal Employment Opportunity counselor—who oversees potential resolutions through informal or formal arbitration—and predates a formal complaint with OPM.
  • Bloomberg Law also reports,
    • “A California law imposing fiduciary duties on pharmacy benefit managers intrudes on federally regulated health insurance plans, the Pharmaceutical Care Management Association said in a lawsuit filed Friday [January 2, 2026, in the U.S. District Court for the Central District of California, No. 2:26-cv-00012].
    • “California’s SB 41 requires PBMs—which oversee prescription drugs for health plans—to act in their clients’ interests and disclose all commissions and conflicts of interest. The law was enacted in October 2025 and applies to self-insured employer plans, which are regulated under the federal Employee Retirement Income Security Act.
    • “PCMA’s lawsuit is the latest salvo in an ongoing battle with state governments, which have enacted a range of laws attempting to curb what they say are abusive business practices. Employers are under fire in federal court over drug prices under their PBM contracts, while Congress and the Trump administration take aim at PBM tactics they say increase drug costs for plans and patients.
    • “California’s law is preempted by ERISA because it affects who is considered a plan fiduciary, which is the “first and most fundamental design decision,” PCMA wrote in its complaint filed in the US District Court for the Central District of California.”

From the public health and medical / Rx research front,

  • The New York Times reports,
    • “In 2000, a landmark study claimed to set the record straight on glyphosate, a contentious weedkiller used on hundreds of millions of acres of farmland. The paper found that the chemical, the active ingredient in Roundup, wasn’t a human health risk despite evidence of a cancer link.
    • “Last month, the study was retracted by the scientific journal that published it a quarter century ago, setting off a crisis of confidence in the science behind a weedkiller that has become the backbone of American food production. It is used on soybeans, corn and wheat, on specialty crops like almonds, and on cotton and in home gardens.
    • “The Environmental Protection Agency still considers the herbicide to be safe. But the federal government faces a deadline in 2026 to re-examine glyphosate’s safety after legal action brought by environmental, food-safety and farmworker advocacy groups.
    • “The E.P.A. has also faced pressure to act on glyphosate from the Make America Healthy Again movement, led by supporters of the health secretary, Robert F. Kennedy Jr., who once served as co-counsel in a lawsuit against Monsanto over exposure to Roundup.”
  • Health Day informs us,
    • “Sleep problems might be an early warning sign of dementia, a new study says.
    • “Circadian rhythms that are weaker and more fragmented are tied to an increased risk of dementia, researchers reported Dec. 29 in the journal Neurology.
    • “In fact, people with weak circadian rhythms have a more than doubled risk of dementia, results showed.
    • “Changes in circadian rhythms happen with aging, and evidence suggests that circadian rhythm disturbances may be a risk factor for neurodegenerative diseases like dementia,” said lead researcher Wendy Wang, an assistant professor of epidemiology and internal medicine at UT Southwestern Medical Center in Dallas.”
  • MedPage Today points out,
    • “Melatonin prescribing for young children appears to have been on the rise globally in recent years, despite a dearth of efficacy data for kids with typical development, a systematic review suggested.
    • “There was evidence for improved sleep onset with melatonin use in young children with neurological conditions, such as autism spectrum disorder.
    • “Data on long-term outcomes for other behaviors and health impacts were lacking.”
  • The American Medical Association lets us know “what doctors wish patients knew about ankle sprains and strains.
  • BioPharma Dive calls attention to “10 clinical trials to watch in the first half of 2026. After a lengthy downturn, the biotech industry finally gathered momentum in 2025. Key readouts in obesity, infectious disease and many rare conditions could help it continue.”

From the U.S. healthcare business and artificial intelligence front,

  • The Washington Post reports,
    • “Novo Nordisk launched the first GLP-1 weight-loss pill Monday with a pledge that manufacturing investments will enable the drugmaker to avoid the type of shortages that plagued the rollout of its injectable version.
    • “The company said doctors can now prescribe the new oral version of Wegovy and patients can pick it up at more than 70,000 pharmacies and via mail-order services throughout the country.
    • “The starting dose of the once-daily pill costs $150 a month for patients without insurance coverage, while the largest dose — on which patients lose the most weight — will be available by the end of the week for $300 a month. For those with employer insurance coverage, the company says it will cost as little as $25 a month.
    • “By introducing the semaglutide-based tablet, the Danish drugmaker is aiming to avoid a pitfall that has cut into sales of its two leading injectable drugs, Ozempic and Wegovy: churning out enough of the medicine to keep up with patient demand. Novo Nordisk executives say they are confident they’ll have enough pills, pointing to the scale of the launch: The pill will be available in pharmacies like CVS and Costco, on telehealth platforms that have partnered with the company, and on Novo Nordisk’s own direct-to-consumer service.”
  • Modern Healthcare relates,
    • “Corewell Health and independent laboratory company Quest Diagnostics have completed their agreement to form a joint venture providing laboratory services. 
    • “The venture, Diagnostic Lab of Michigan will be based at the Corewell Health Southfield Center in Southfield, Michigan. The facility is slated to open in the first quarter of 2027. 
    • “Quest Diagnostics owns 51% of Diagnostic Lab of Michigan and Corewell, which has dual headquarters in Southfield and Grand Rapids Michigan, owns 49%, according to a Monday news release. Further financial terms were not disclosed.” 
  • The Wall Street Journal tells us,
    • “Health systems are increasingly adopting AI, with 27% paying for commercial AI licenses, triple the rate across the U.S. economy.
    • “AI tools have significantly reduced report-writing time for radiologists and cut staff time on denied insurance claims by as much as 23%.
    • “Despite efficiency gains, AI can produce fabricated information.”
  • Beckers Health IT adds,
    • More than 40 million Americans use ChatGPT daily to ask questions about healthcare, according to a new report from OpenAI that highlights how patients and clinicians are increasingly turning to AI to navigate a complex and strained U.S. healthcare system.
    • The report, AI as a Healthcare Ally: How Americans Are Navigating the System With ChatGPT, was shared with Becker’s by an OpenAI spokesperson. It is based on anonymized ChatGPT message data and OpenAI-led research.
    • The article offers eight findings from the OpenAI report.
  • Per Beckers Hospital Review,
    • “Nashville, Tenn.-based HCA Healthcare is facing resistance to its expansion efforts across multiple states, as competing health systems challenge the for-profit giant’s push to add new emergency rooms, surgery centers and hospitals in regions where it already has a presence.”
  • and
    • “Patients in Washington, D.C., had the highest median time spent in the emergency department, while patients in North Dakota had the lowest, CMS data shows.
    • “The agency’s “Timely and Effective Care” dataset, updated Nov. 26, tracks the average median time patients spend in the emergency department before leaving. The measures apply to children and adults treated at hospitals paid under the Inpatient Prospective Payment System or the Outpatient Prospective Payment System, as well as those that voluntarily report data on relevant measures for Medicare patients, Medicare managed care patients and non-Medicare patients.” 

First FEHBlog Report of 2026

David Ermer–CDC, COVID-19, FDA, Federal employment benefits, Medical / Rx research, OPM, Rx coverage, U.S. Healthcare–

Happy New Year!

From Washington, DC

  • OPM Director Scott Kupor added a post to his Secrets of OPM blog about return to office policies.
  • Federal News Network reports,
    • “The specifics of a larger federal pay raise for law enforcement officers are coming into view, following President Donald Trump’s directive to offer a 3.8% salary increase for certain positions.
    • “In a memo Wednesday, the Office of Personnel Management established new “special salary rates” for federal law enforcement personnel [December 31], as a way to implement the bigger raise for 2026.”
  • MedPage Today tells us,
    • “The FDA approved tradipitant (Nereus), an oral neurokinin-1 (NK-1) receptor antagonist, to prevent vomiting induced by motion in adults, Vanda Pharmaceuticals announcedopens in a new tab or window Tuesday.
    • “The approval marks the first new drug treatment for motion sickness in over four decades and signifies an advancement in understanding motion sickness mechanisms, the company said.”

From the judicial front,

  • Federal News Network reports,
    • “The Trump administration is facing a new legal complaint from a group of government employees who are affected by a new policy going into effect Thursday that eliminates coverage for gender-affirming care in federal health insurance programs.
    • “The complaint, filed Thursday [with the Equal Employment Opportunity Commission] on the employees’ behalf by the Human Rights Campaign, is in response to an August announcement from the Office of Personnel Management that it would no longer cover “chemical and surgical modification of an individual’s sex traits through medical interventions” in health insurance programs for federal employees and U.S. Postal Service workers.
    • “The complaint argues that denying coverage of gender-affirming care is sex-based discrimination and asks the personnel office to rescind the policy.” * * *
  • Bloomberg Law informs us,
    • “Drugmakers Eli Lilly & Co., Novo Nordisk Inc., and Sanofi-Aventis US LLC and pharmacy benefit managers such as Express Scripts won’t face certain civil fraud claims in connection with alleged price-fixing of diabetes treatment drugs.
    • “The plaintiff health benefit managers and trusts were barred from asserting civil claims under the Racketeer Influenced and Corrupt Organizations Act because they didn’t directly purchase the drugs, but rather reimbursed their members for the cost, the US District Court for the District of New Jersey said Tuesday.
    • “The “indirect purchaser rule” developed by the US Supreme Court in the antitrust context holds that Clayton Act plaintiffs may not demonstrate injury by providing evidence only of indirect purchases.
    • “Judge Brian Martinotti said the rule also applies in RICO cases, citing recent decisions from the US Court of Appeals for the Third Circuit applying it in factual situations similar to that alleged here because RICO’s private cause of action was modeled on the Clayton Act.”

From the public health and medical / Rx research front,

  • Due to New Years Day falling on a Thursday, the Centers for Disease Control and Prevention released their respiratory news update last Tuesday, December 30.
    • “As of December 30, 2025, the amount of acute respiratory illness causing people to seek health care is at a high level for the first time in the current 2025-2026 season.
    • “Seasonal influenza activity is elevated and continues to increase across the country.
    • “RSV activity is elevated in many areas of the country with emergency department visits and hospitalizations increasing among children 0-4 years old.
    • “COVID-19 activity is low but increasing nationally.”
  • STAT News relates,
    • “Babies who don’t get their first round of vaccines on time at 2 months of age are much less likely to get vaccinated against measles, mumps, and rubella by age 2, according to a new study that suggests pediatricians may have a narrow window in which to persuade parents to follow the recommended childhood vaccination schedule. 
    • “The study, published Friday in JAMA Network Open, reports that in the post-Covid-19 pandemic period, babies who didn’t get their shots on time at 2 months — the age at which the Centers for Disease Control and Prevention recommends babies get vaccines against a host of diseases — were more than seven times more likely not to receive their first measles, mumps, and rubella (MMR) shot by age 2, which is months later than when that shot is supposed to be given. Babies are supposed to get their first MMR shot between 12 months and 15 months of age, with a second sometime between the ages of 4 and 6.
    • “There’s evidence from this study that very early vaccination delays lead to later vaccination delays and even missed vaccination for measles,” said Nina Masters, an epidemiologist who is the lead author of the paper. “This shows that hesitancy is really starting early and has a long arc.”
    • “And as we look at a really bad measles year, it’s really important to do whatever we can to try to increase measles vaccination coverage.” 
  • Healio tells us,
    • “Early-onset preeclampsia was associated with increased risk for delayed early-childhood development in the domain of problem-solving among preterm children, researchers reported.
    • “Although other domains of child development were affected by hypertensive disorders of pregnancy (HDP) and its subtypes, the relationships were not statistically significant, according to data published in JAMA Network Open.
  • MedPage Today recounts what happened with bird flu in 2025.
  • The Wall Street Journal lets us know,
    • “Move over weight loss and dry January. There’s a new popular New Year’s resolution in town: Enter the digital detox.
    • “Some people are aiming to reduce overall screen-time or social-media use (including yours truly). Others want to carve out regular no-screen days—OK, maybe more like time periods—or days or retreats.
    • “A survey by the digital-wellness app Opal (granted, a bit of a biased audience) found that 33% of 1,306 users said reducing screen times and being more present was their top New Year’s resolution, compared with 28% who aimed to lose weight. 
    • “Even teens are voicing a desire to reduce screen time. A Boston Children’s Digital Wellness Lab report cited results from a survey of more than 1,500 teens and found that 63% said they use their phones too much and 47% said they used apps or tools to manage phone use. 
    • “It’s high time we all cut down. There are growing signals it’s bad for our mental health—especially among adolescents and young adults.
    • “A recent study in JAMA Network Open found that when young adults did a social-media detox for a week they had a reduction in anxiety and depression symptoms, as well as less insomnia.”
  • The Washington Post points out,
    • A fatty particle can clog arteries just as surely as cholesterol but often goes undetected, striking seemingly healthy people unaware of the danger. Though tests are widely available, they aren’t routinely ordered — in part because there are no approved treatments for the genetic disorder.
    • Now, cardiologists waging a campaign against lipoprotein(a) say they are reaching a turning point. Five experimental drugs are in late stages of development and aim to prove that lowering levels of Lp(a) — pronounced “L-P-little-A” — reduces heart attacks and strokes. Results from the most advanced clinical trial are expected in the first half of 2026.
    • “Cardiologists, drugmakers and Wall Street analysts are optimistic that these new drugs can effectively treat a disorder that is estimated to affect about 20 percent of the world’s population. Even if they prove effective, the cost of a novel drug — as well as the scant public awareness of Lp(a) — could be a barrier to treating patients who might benefit.
    • “There are over a billion people on our planet that have elevated lipoprotein levels and that are at increased risk,” said Steve Nissen, a cardiologist at Cleveland Clinic whose team is leading trials on four drugs targeting Lp(a). “We will have a massive educational job to do.”

From the U.S. healthcare business front,

  • Fierce Healthcare reports,
    • “Hartford HealthCare closed its $86.1 million purchase of two Connecticut cate care hospitals, the 249-bed Manchester Memorial and its 109-bed Rockville campus, plus their related assets, from bankrupt Prospect Medical Holdings on Jan. 1.
    • “The transaction comes after the system spent months securing regulatory and state approvals, which involved commitments to maintain certain services and limit its rate negotiations with payers during the next few years. The most recent of these, an agreement with Connecticut Attorney General William Tong, came on Dec. 29
    • “Hartford HealthCare said it also plans to invest $225.7 million over three years into the hospitals and their communities. These efforts, as highlighted in this week’s announcement, include additional hiring, stronger outpatient and ambulatory care services, 24/7 virtual primary care offerings and the reopening of a 30-bed behavioral care unit at Rockville.”
  • Reuters relates,
    • “Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts, according to data provided exclusively by healthcare research firm 3 Axis Advisors.
    • “The number of price increases for 2026 is up from the same point last year, when drugmakers unveiled plans for raises on more than 250 drugs. The median of this year’s price hikes is around 4% – in line with 2025.
  • Genetic Engineering and BioTechnology News calls attention to “Seven Biopharma Trends to Watch in 2026.”
  • Beckers Clinical Leadership tells us
    • “Of the 650 U.S. hospitals designated as “Magnet” hospitals for nursing excellence, about 5% have earned the recognition more than six times. 
    • “The American Nurses Credentialing Center awards Magnet recognition to hospitals based on their quality of patient care and nursing excellence. As of Dec. 31, 33 hospitals have received six or more Magnet designations — representing just 0.54% of the nation’s 6,093 hospitals.”
    • The article lists those 33 hospitals by State.  

Tuesday report

David Ermer–ACA, HIPAA Privacy and Security Rules, Medical / Rx research, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • Govexec identifies the five biggest stories for federal agencies and employees to watch in 2026.
    • 1.) Renewed shutdown watch
    • 2.) Return of RIFs? 
    • 3.) The implementation of ‘Schedule F’ and other changes to the civil service
    • 4.) Agency reorganizations
    • 5.) Court battles 
  • Beckers Payer Issues informs us,
    • “More than 15.6 million people have enrolled in plans on federally run ACA exchanges so far, down from about 16 million at the same point last year, CMS Administrator Mehmet Oz, MD, said Dec. 23.
    • “Dr. Oz attributed the decline to efforts to address fraudulent enrollments, writing on X: “Notably, this small drop follows several important CMS actions over the past year to combat fraudulent and improper enrollments, which have already removed more than enough people from premium subsidies who are covered elsewhere to account for the modest enrollment change. That said, there is a politically motivated lawsuit that has paused critical actions to make sure Biden-era improper enrollments are fully knocked out.”
    • ‘Earlier in the open enrollment period, ACA enrollment was outpacing last year. CMS data published Dec. 5 showed nearly 5.8 million plan selections through late November, up about 7% year over year, though new consumer enrollment was down 4% as returning consumers drove the gains.”
  • According to a Competitive Enterprise Institute news release,
    • “A new Competitive Enterprise Institute (CEI) study explores a thriving pharmaceutical delivery system that offers consumers real choice and convenience. Independent pharmacies are doing well and still make up a sizable portion of retail pharmacies. At the same time, new approaches like mail-order pharmacies and combined telehealth and pharmacy offerings are making it easier and cheaper than ever for patients to obtain necessary medications. And these new innovative approaches are providing access to rural areas that lack physical pharmacies.
    • “Invaluable to this well-functioning system is the role of pharmacy benefit managers (PBMs). PBMs own and manage most mail-order pharmacies, negotiating drug prices and running an efficient distribution network. PBMs provide convenient, reliable drug delivery to patients, making it easier for patients to stick to their treatment plan.
    • “But some lawmakers at the state and federal levels fear that PBMs wield too much influence over products and services, and they want to ban PBMs from owning pharmacies, whether mail-order services or retail stores like CVS. Perhaps they have not considered that in some rural counties, the only pharmacy available would be in danger of closing under these laws—potentially leaving residents in those areas with no local options.
    • “There is little evidence to suggest that worries about PBM-owned pharmacies are justified, and consumers are already protected from anticompetitive practices by existing laws.
    • “Banning successful business models doesn’t protect consumers; it protects competitors from competition,” said study author and CEI senior fellow Jeremy Nighohossian. “When it comes to building a system that works better for consumers, the free market is the best medicine.”
  • Modern Healthcare reports,
    • “The Drug Enforcement Administration on Tuesday temporarily extended a rule allowing clinicians to prescribe controlled medications remotely through the end of 2026.
    • “The rule, which will take effect Thursday, gives clinicians the ability to remotely prescribe Schedule II-V controlled medications to patients. This latest extension marks the fourth time the rule has been renewed since it was implemented at the beginning of the COVID-19 pandemic.
    • “Under the rule, clinicians are able to prescribe controlled medications, such as Adderall and Xanax via telemedicine appointments, without an initial in-person examination. The rule was originally set to expire at the end of December.”
  • The Holland and Knight law firm lets us know,
    • “Recent changes to the HIPAA Privacy Rule require that healthcare providers update their Notice of Privacy Practices (“NPP”) by February 16, 2026. The changes are intended to align HIPAA with the revised regulations governing substance use disorder records in 42 CFR part 2 (“Part 2”). A redlined version of 45 CFR 164.520 showing the changes to the rule is available here here.”

From the public health and medical / Rx research front,

  • The Wall Street Journal reports,
    • “Influenza cases are rising sharply, heightening fears that a new strain will fuel a punishing flu season that is already outpacing last year’s.
    • “The flu has sickened an estimated 7.5 million people so far this season, according to weekly data from the Centers for Disease Control and Prevention released Tuesday. About 81,000 people have been hospitalized and 3,100 have died so far this flu season, the agency estimated, including eight children. That reflects a sharp increase from the week prior, in which the CDC estimated about 4.6 million cases, 49,000 hospitalizations and 1,900 deaths. 
    • “Roughly 25% of samples sent to clinical laboratories came back positive for the flu in the week ended Dec. 20, the CDC said. That is up from about 15% the week before. 
    • “The figures raised concerns of a particularly harsh flu season this winter. The contagious respiratory illness typically kills thousands of people in the U.S. each year, though that number can rise significantly in years with troublesome viral variants.” 
  • The University of Minnesota’s CIDRAP tells us,
    • “Measles cases nationwide have reached 2,012, the Centers for Disease Control and Prevention (CDC) reported last week, as outbreaks in Arizona and South Carolina continue to grow and three other states alert the public about airport exposures.
    • “The US total reflects 54 new cases, as the country teeters on the brink of losing its measles elimination status—which it earned in 2000—next month. This year’s total is the nation’s highest since 1992, when officials reported 2,200 cases. Coordinated vaccination efforts led to a precipitous drop in cases in the ensuing decades, but vaccine skepticism in recent years has spawned the disease’s resurgence.”
  • and
    • “Relative to uninfected control patients, those hospitalized with acute respiratory infections (ARIs) due to respiratory syncytial virus (RSV) or influenza were at substantially higher adjusted risk for all-cause death, heart attack, exacerbation of asthma and chronic obstructive pulmonary disease (COPD), and hospitalization for heart failure, researchers from vaccine maker GSK and the Analysis Group report.
    • “The retrospective study, published last week in Clinical Infectious Diseases, used claims data from October 2015 to June 2023 to compare clinical outcomes among US adults aged 50 and older hospitalized for RSV or flu with those of controls without ARI. The average ages in the RSV and flu cohorts were higher than those of controls (76.5 and 75.4 vs 69.5 years, respectively).
    • “Current evidence on longer-term RSV-ARI outcomes among adults aged ≥50 years is limited, with insufficient research comparing the impact of RSV-ARI hospitalization to an appropriate comparator population representing the long-term health outcomes these patients would have experienced without severe RSV disease,” the study authors wrote.”
  • The New York Times relates,
    • “Rarely does a single study change the course of gynecological history. But a clinical trial published this year in The New England Journal of Medicine did just that, seeming to close the door on one of the great enigmas of women’s health.
    • “Bacterial vaginosis, or B.V., is the most common vaginal infection worldwide. If you have a vagina, there’s a one-in-three chance you will have B.V. at some point in your life.
    • “For years, doctors have known that the bacteria associated with the condition could also be found on the penis. Yet on paper B.V. was just a vagina problem — it’s right there in the name, vaginosis. For 50 years, gynecology treated it as if it were solely a women’s issue, with ineffective treatments that left women vulnerable to re-infection.
    • “The New England Journal study changed that. The researchers followed 150 heterosexual couples in which the female partner had bacterial vaginosis. They treated the women with first-line antibiotics, and half the men with both oral and topical antibiotics. Within three months, they found, the partner treatment worked so well that they had to disband the study so all participants could be treated.”
  • Medscape points out,
    • “Rates of gestational diabetes (GD) in the US rose every year from 2016 to 2024, with a total 36% jump in that 9-year period, new data showed.
    • “The data, from nearly all first live singleton births recorded in the National Center for Health Statistics, also showed that GD rose among all racial and ethnic groups, but with significant differences among them.
    • “The dramatic GD rise “likely reflects several factors including increasing prevalence of prepregnancy overweight and obesity, older maternal age at first birth, and higher rates of metabolic risk factors entering pregnancy. The COVID-19 pandemic may have further contributed to these trends through disruptions in routine preventive care, reduced physical activity, increased psychosocial stress, and weight gain during the pandemic period,” study first author Emily L. Lam, medical student at Northwestern University, Chicago, told Medscape Medical News.”

From the U.S. healthcare business and artificial intelligence front,

  • Fierce Healthcare reports,
    • “Brooklyn, New York-based Maimonides Health is merging with New York City’s public health system NYC Health + Hospitals, the organizations announced Dec. 29.
    • “The merger is pending final legal and regulatory approval but is expected to be finalized by April, city officials said.
    • “The partnership is supported by $2.2 billion over five years from New York state to protect safety net healthcare in Brooklyn, officials said.”
    • “Maimonides Health is a Brooklyn healthcare system with three hospitals and more than 80 community-based sites. By partnering with the city, Maimonides will be reimbursed at a higher rate by Medicaid, bolstering its financial position, health system executives said in a press release. 
    • “The merger also allows Maimonides to adopt a new Epic electronic health record platform. Health system executives said the move to Epic would help improve care coordination and the organization’s ability to collect revenue. Maimonides patients will be able to access their health records online and contact their care team digitally through the portal.”
  • Per Beckers Health IT,
    • “Healthcare organizations are increasingly adopting artificial intelligence to improve efficiency and reduce administrative burden, but most remain cautious about deploying AI in high-risk clinical scenarios, a Dec. 29 KLAS Research report found.”

Weekend update

David Ermer–Congress, FDA, Medical / Rx research, Medicare, Mental health care, Rx coverage, U.S. Healthcare–

From Washington, DC

  • Congress is out of session again this week. The House of Representatives begins its 2026 session on January 6 while the Senate begins its 2026 session on January 5.
  • The American Bazaar tells us,
    • “Around 25,000 people have expressed interest in joining the “Tech Force,” a cadre of engineers to be hired by the Trump administration as it looks to install staff with artificial intelligence expertise in federal roles.
    • “The Trump administration will use that list to recruit software and data engineers, in addition to other tech roles, said Scott Kupor, director of the U.S. Office of Personnel Management, in a post on X. The 25,000 figure has been provided by a senior Trump administration official, according to a Reuters report.”
  • Beckers Hospital Review informs us,
    • “The Department of Homeland Security will replace the random lottery used to select H-1B visa recipients with a system that gives greater weight to applicants with higher skills.”
    • The article lets us know five things about this change.

From the Food and Drug Administration front,

  • Fierce Pharma points out,
    • “It’s been a long time coming: Four years after Omeros came up short in its bid to gain an FDA approval for stem cell transplant drug narsoplimab, the Seattle biotech has finally scored its long-awaited nod.
    • “With a Christmas Eve thumbs-up for narsoplimab, the FDA has delivered Omeros its first U.S. approval in its 31 years. Taking on the commercial name Yartemlea, it also becomes the first treatment for hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA). The first-in-class lectin pathway inhibitor is for patients age 2 and older.
    • By selectively inhibiting MASP-2, which is the effector enzyme of the lectin pathway, Yartemlea blocks activation while preserving complement functions important for host defense.”

From the public health and medical / Rx research front,.

  • The Washington Post reports,
    • “When Marc and Cristina Easton’s son was diagnosed with autism at 20 months, the Baltimore couple left the doctor’s appointment in confusion. Their toddler — who was very social — didn’t resemble the picture of the condition they thought they knew. And the specialists could offer little clarity about why or what lay ahead.
    • “It wasn’t until four years after their child’s diagnosis that the Eastons finally began to get answers that offered them a glimmer of understanding. This summer, a team from Princeton and the Flatiron Institute released a paper showing evidence for four distinct autism phenotypes, each defined by its own constellation of behaviors and genetic traits. The dense, data-heavy paper was published with little fanfare. But to the Eastons, who are among the thousands of families who volunteered their medical information for the study, the findings felt seismic.
    • “This idea that we’re seeing not one but many stories of autism made a lot of sense to me,” Cristina said.”
  • The New York Times relates,
    • “The egg has become a dominant source of anxiety for many women. Human eggs are finite, declining in both quality and quantity with age. In a woman’s 30s, this starts to make it harder to get pregnant, and by menopause, a woman is without functional eggs. Growing awareness of this reproductive reality has led to a surge in egg freezing, as women aim to preserve the vitality of their younger eggs.
    • “But there’s more to infertility than old eggs. Recent research is bringing greater attention to the ovaries.
    • ‘An expanding body of evidence suggests that the age of an ovary, not just the eggs it contains, is important to reproduction and healthy aging. That includes the cells and tissues that make up the environment around a woman’s eggs, such as support cells, nerves and connective tissue.
    • “The tissues surrounding the follicles — fluid-filled sacs that contain an immature egg — can change with age, even becoming fibrotic. Research has shown that this can harm the quality of eggs, reduce the number that mature each month and block ovulation. Fibrosis is common in many aging organs as thick, scarlike tissue builds up. But it occurs decades earlier in the ovaries.”
  • The Wall Street Journal lets us know,
    • “Approved by the Food and Drug Administration decades ago for seizures and nerve pain from shingles, gabapentin is now the seventh-most widely prescribed drug in the U.S., according to the Iqvia Institute for Human Data Science. About 15.5 million people were prescribed gabapentin in 2024, according to an analysis by Centers for Disease Control and Prevention researchers. 
    • “Studies show that most of the prescriptions are written to treat conditions that it wasn’t approved for—a practice that is legal and common, but means the FDA hasn’t vetted its risks and benefits for those purposes.
    • “Some doctors say gabapentin can be helpful for certain types of neuropathic pain, a condition resulting from nerve damage. But doctors also give it to patients with other types of chronic pain, anxiety, migraines, insomnia, distorted sense of smell and hot flashes in menopause. Veterinarians dispense it to calm or treat pain in cats and dogs.
    • “A growing body of research shows it isn’t as safe or effective as doctors have long thought. Gabapentin has been associated in studies with greater risk of dementia, suicidal behavior, severe breathing problems for people who have lung disease, and edema, in addition to well-known side effects like dizziness.
    • “A study published this year found giving gabapentin to surgery patients didn’t reduce complications or get them out of the hospital any faster, and more of them reported pain four months after surgery. Doctors for years had touted gabapentin as a way to use fewer opioids. 
    • ‘While the medical establishment has mostly maintained that gabapentin isn’t habit-forming, some patients have reported debilitating adverse effects when they try to taper off it. They say the withdrawal symptoms make it clear to them they have developed a dependence to the drug taking it as prescribed.”
  • and
    • summarizes “The Future of Everything’s top stories of the year, including a formula for aging, fruit-picking robots and the car of the future.”
      • “This longevity doctor has a formula for aging better. Dr. Eric Topol’s research suggests lifestyle impacts longevity more than genes. The cardiologist believes more people can become “super agers” by embracing regular exercise and digital health technology.”
      • “Inflammaging” leads to cancer, but allergy drugs could help fight it. Dr. Miriam Merad is testing whether allergy drugs and other seemingly unlikely medications can help reduce chronic inflammation—or inflammaging—and thereby slow cancer in older patients.

From the U.S. healthcare business front,

  • The Wall Street Journal reports,
    • “Mail-order pharmacies filled just 9% of Medicare prescriptions in the three-year period examined by the Journal, but accounted for 37% of the excess dispensing, the analysis showed. Such pharmacies often send 90-day refills automatically when patients near the end of their earlier supplies.” * * *
    • “The Journal’s analysis counted as excess only dispensed prescription drugs that exceeded a month’s supply over up to three years’ worth of prescriptions.” * * *
    • “The Journal analysis is based on Medicare prescription records accessed under a research agreement with the federal government. The records include details of each individual prescription for more than 50 million Medicare recipients between 2021 and 2023, but don’t identify individuals. 
    • “Doctors and patients said such earlier-refilling practices aren’t limited to Medicare patients, and that it also happens with people covered by employer-sponsored plans. The Journal analysis doesn’t cover those private plans.”
  • Beckers Payer Issues identifies six insurer moves in 2025 that signal a heightened PBM focus.
  • Fierce Healthcare offers a 2026 outlook based on parting thoughts from dozens of healthcare CEOs retired in 2025.
  • HR Dive shares its “top 10 learning stories of 2025. Workers sounded off about the need for more training and just how great a role the onboarding experience plays in their retention.”

Tuesday report

David Ermer–CMS, FDA, HSA, Medical / Rx research, Medicare, OPM, Patient safety, Rx coverage, U.S. Healthcare–

The FEHBlog will be on hiatus following today until next December 27 Cybersecurity Saturday. Merry Christmas and Jingle Bells to all.

From Washington, DC,

  • Federal News Network reports,
    • “There’s an old adage that tells someone to “put your money where your mouth is.” Well, Don Bauer is going all in at the Office of Personnel Management.
    • “Bauer wrote a column for Federal News Network criticizing OPM’s plans to consolidate and modernize human resources systems across the government. In his Oct. 30 column, Bauer wrote that OPM’s initial plan was “not modernization; it’s madness.”
    • “Now Bauer is in charge of that madness. Federal News Network has learned Bauer will join OPM on Jan. 12 as its new deputy associate director for workforce standards and data center (WSDC) in the HR Solutions (HRS) office. He will be leading the HR Line of Business, the quality service management office (QSMO) and human capital management core modernization effort.”
  • Good luck, Mr. Bauer.
  • Mercer tells us,
    • “In Notice 2026-5, IRS and the Treasury Department provide key details about health savings account (HSA) enhancements passed as part of the One Big Beautiful Bill Act (OBBBA) (Pub. L. No. 119-21), clearing the way for employers to continue offering telehealth and to begin offering direct primary care service arrangements (DPCSAs) to otherwise HSA-eligible employees.
    • “Effective for the 2025 plan year, OBBBA reinstated and made permanent COVID-19-era telehealth relief allowing HSA-compatible high-deductible health plans (HDHPs) to cover telehealth and other remote care services before the statutory minimum deductible is satisfied.
    • “Beginning Jan. 1, 2026, OBBBA also allows individuals enrolled in DPCSAs to remain eligible to make or receive HSA contributions and treats certain bronze and catastrophic plans as HDHPs.
    • “This article summarizes the Notice 2026-5 question-and-answer guidance, addressing significant topics such as which services the IRS will treat as “telehealth and other remote care services;” whether a DPCSA can separately bill for primary care services or offer services beyond primary care; and whether a bronze or catastrophic plan can be an HDHP if purchased using an employer-sponsored individual coverage health reimbursement account (ICHRA).
    • ‘Comments about the guidance are due March 6, 2026.”
  • Per a CMS news release,
    • “The Centers for Medicare & Medicaid Services (CMS) announced today a new voluntary test of a model that is designed to enable Medicare Part D plans and state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health improvement, while helping control costs for patients and taxpayers.
    • “The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model builds on emerging evidence that combines access to GLP-1 medications with access to evidence-based lifestyle supports to achieve better long-term health outcomes. The model represents a major step toward potential expanded access and affordability for millions of Americans. 
    • “Today’s announcement builds upon our historic Most Favored Nations drug pricing deals’ goal of democratizing access to weight-loss medication, which has been out of reach for so many in need,” said CMS Administrator Dr. Mehmet Oz. “These actions further the administration’s bold plan to reform our country’s health systems and Make America Healthy Again. With the BALANCE Model, we’re pairing breakthrough science with healthy living to cut costs while empowering Americans to take control of their health.”
    • “Under the model, CMS negotiates directly with pharmaceutical manufacturers of GLP-1 drugs for lower net prices and standardized coverage terms. Negotiation areas include: 
      • “Guaranteed net pricing and potential out-of-pocket limits for beneficiaries;
      • “Standardized coverage criteria; and
      • “Evidence-based lifestyle support offerings.”
    • “To learn more about the BALANCE Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/balance.” * * * 
    • “Prior to the launch of the BALANCE model, CMS also plans to implement a new Medicare GLP-1 payment demonstration beginning in July 2026, which will serve as a short-term bridge to the model. This additional payment demonstration means that Medicare beneficiaries can start accessing these important medications at prices negotiated by the Administration as soon as possible.
    • “The GLP-1 payment demonstration will operate outside of the Medicare Part D benefit’s coverage and payment flow, which means that Part D Plan Sponsors will not carry risk for eligible GLP-1 products furnished under the demonstration. Beneficiaries enrolled in Medicare Part D who meet the negotiated access criteria will have access to these drugs. Under the demonstration eligible Medicare beneficiaries will pay $50 for a month of GLP-1 medications.
    • “CMS will provide additional information on the design and implementation of the GLP-1 payment demonstration in early 2026.
  • The Wall Street Journal points out,
    • “About half of 20 million Americans with FSA [healthcare flexible spending] accounts let some of their money expire each year.
    • “The average forfeited amount per individual is over $400, and unused FSA money generally returns to employers.
    • “FSAs offer tax savings; a worker in the 22% tax bracket contributing $1,500 could save as much as around $500 in taxes.”
  • Per an AHIP news release from December 18,
    • “AHIP’s Board of Directors has elected Jim Rechtin, President and CEO of Humana, as Board Chair effective January 1, 2026. Rechtin succeeds Pat Geraghty, who announced his retirement after 14 years leading GuideWell and Florida Blue effective December 31, 2025.
    • “I was proud to be part of AHIP’s work this year to unite our industry around voluntary commitments to simplify prior authorization – an important ongoing effort that shows what’s possible when health plans work together to deliver for patients. As Board Chair, I look forward to taking the same cooperative approach to helping health consumers navigate the system and access high-quality, affordable care,” Rechtin said.

From the Food and Drug Administration front,

  • MedPage Today tells us,
    • “The FDA has expanded the indication of ferric maltol (Accrufer) capsules for the treatment of iron deficiency to include adolescents.
    • “The approval makes the drug the first prescription oral medicine for iron deficiency in pediatric patients ages 10 and older. It was first approved in 2019 for adults with iron deficiency.
    • “The expanded indication was supported by the phase III FORTIS trialopens in a new tab or window in which 24 patients ages 10-17 received age-based dosing of ferric maltol twice daily, and showed a clinically meaningful average increase in hemoglobin of 1.1 g/dL at 12 weeks. This would be the expected average increase in hemoglobin with one blood transfusion, the agency noted.”
  • MedTech Dive reports,
    • “Edwards has received Food and Drug Administration approval for its Sapien M3 mitral valve replacement system, the company said Tuesday.
    • “The device is intended for people with moderate to severe mitral regurgitation, a heart condition where the valve between the left heart chambers doesn’t fully close, allowing blood to leak back through. Sapien M3 is indicated for people who are deemed unsuitable for surgery or transcatheter edge-to-edge repair therapy, a minimally invasive procedure to fix a valve by clipping its leaflets together.”
  • and
    • “The Food and Drug Administration said Monday it has issued a Class I recall notice regarding Medtronic’s removal of heart vent catheters.
    • “Medtronic previously asked customers to quarantine lots of its DLP Left Heart Vent Catheters in response to an issue linked to three serious injuries. The FDA published an early alert about the recall in August.
    • “The agency updated its notice this week to inform the public that it has classified the issue as a Class I recall.” 

From the public health and medical / Rx research front,

  • MedPage Today reports,
    • “Infants given the monoclonal antibody nirsevimab, which provides temporary immunity to respiratory syncytial virus (RSV), had lower risks of related hospitalizations and severe outcomes than those whose mothers got the RSVpreF vaccine, according to a population-based study.
    • “The study may be the first to compare the two interventions in a real-world setting in a national population.
    • “The study and two others reported alongside it join a growing body of real-world evidence demonstrating the effectiveness of RSV products in protecting against severe outcomes related to RSV in the youngest kids.”
  • Health Day informs us,
    • “People on the verge of type 2 diabetescan cut their risk of death from heart disease by more than 50% if they bring their blood sugar levels back to normal, a new study says.
    • “Patients with prediabetes reduced their heart risk by up to 58% when they successfully lowered their blood sugar, researchers reported in The Lancet Diabetes & Endocrinology.
    • “This is an important finding, given that recent studies have concluded people with prediabetes can’t lower heart disease risk through lifestyle changes like exercise, weight loss and a healthy diet, researchers said.
    • “Essentially, reversing prediabetes by lowering blood sugar matters more to your heart than any healthy habits you adopt, researchers said.
    • “This study challenges one of the biggest assumptions in modern preventative medicine,” said lead researcher Dr. Andreas Birkenfeld, a reader in diabetes at King’s College London.
  • Medscape points out,
    • “A trio of large observational studies reported at the San Antonio Breast Cancer Symposium (SABCS) 2025 suggest that GLP-1 receptor agonists may improve outcomes in some women with breast cancer.
    • “Two studies reported an overall survival benefit of GLP-1 use in certain patients with breast cancer, including those with ductal carcinoma in situ (DCIS) and invasive hormone receptor (HR)-positive nonmetastatic disease, and a third found improvements in a range of toxicities among patients receiving chemotherapy.
    • “These studies, presented during a poster session, add to other emerging research indicating that GLP-1 drugs could have implications across the breast cancer trajectory, including prevention, active therapy, and posttreatment survivorship, explained study discussant Jasmine S. Sukumar, MD, with University of Texas MD Anderson Cancer Center in Houston.”
  • Fierce Pharma relates,
    • “Just days after an upbeat R&D event, Neurocrine Biosciences has found itself having to report a phase 3 failure.
    • “The company’s Ingrezza (valbenazine), approved to treat certain uncontrolled movement conditions, failed to make a significant difference in a phase 3 trial for patients with dyskinesia due to cerebral palsy (CP), Neurocrine announced Monday.
    • “Ingrezza didn’t outperform placebo on improving involuntary, jerky movements of the body after 14 weeks of treatment, causing the phase 3 trial to miss its primary endpoint. The study, dubbed Kinect-DCP, also did not meet key secondary endpoints, according to Neurocrine.”
  • and
    • “A patient in an open label extension study of Pfizer’s hemophilia treatment Hympavzi has died, the company and several hemophilia advocacy groups confirmed this week.
    • “Pfizer is now working with its trial investigator and independent data monitoring committee to accrue more information and better understand the circumstances behind the incident, the New York drugmaker wrote in a letter to the hemophilia community, which was posted online (PDF) by the World Federation of Hemophilia (WFH) on Dec. 22.”
  • STAT News reports,
    • “Oncologists have been moving away from the notoriously unpopular neutropenic diet. It requires nearly all food to be cooked to high temperatures — or, as some have described it, “boiled to death” — to reduce the risk of food-borne illnesses. But since evidence in recent years suggested the diet didn’t actually help ward off infections, doctors started leaning away from a strict neutropenic diet.
    • “Now, a new study published last week in the Journal of Clinical Oncology is giving some physicians pause about fresh fruits and vegetables for patients whose treatment involves heavy suppression of the immune system, particularly neutrophils, white blood cells that are key to preventing infection. Contrary to research in the past, the trial found that certain blood cancer patients who were allowed a less restrictive or liberalized diet had 11% more infections than patients who were prescribed the neutropenic diet.”

From the U.S. healthcare business front,

  • Modern Healthcare reports,
    • “Analysts expect health insurance companies to be better positioned for 2026 after adjusting their offerings.
    • “Medicare Advantage offers the sector the largest potential for improvement because companies will receive a significant increase in federal pay. 
    • “Federal changes to Medicaid and the exchanges will pressure health insurance companies’ finances.”
  • Ernst & Young informs us,
    • “A changing healthcare landscape is shifting economic returns, leading organizations to rethink their value chain position.
    • “Expansion in lower-acuity care and opportunistic mergers and acquisitions can accelerate long-term growth.
    • “Implementing new benefit cost containment strategies and investing in innovative AI solutions can elevate efficiency and performance.”
  • Per a Harvard Business Review article,
    • “U.S. employers are grappling with surging healthcare costs as healthcare prices and service volumes rise. Provider consolidation, high drug prices, labor shortages, and growing chronic disease are fueling the cost increases. Employer have largely responded by shifting expenses to workers. Their track record in pursuing aggressive options—including collective purchasing, tiered plans, value-based care, and advocating for changes in government policies—is poor. The big question is whether they have the will to become more aggressive in pursuing remedies. The outlook is not promising. The reasons include the complexity of the problem, employee resistance to some solutions, and the fact that most employers just don’t have sufficient “skin in the game” to take on the disruption and risk that would be required to bend the healthcare cost curve significantly or sustainably.”
  • The FEHBlog has more confidence in employers.

FEHBlog response to public comment

  • A commenter called into question the statistices upon which AHIP relied in this recent news release which the FEHBlog quoted. In response the FEHBlog notes that the AHIP news release was generated in response to the Affordable Care Act marketplace subsidy controversy and 2020 was an outlier year for all health insurers as it was the first year of the Covid pandemic. Health plans did make MLR rebates in that year according to CMS.

Monday report

David Ermer–CDC, FDA, Generative AI, Medical / Rx research, Mental health care, OPM, Patient safety, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • OPM’s leadership posted an end of the year letter to OPM employees.
  • STAT News reports,
    • “Drug manufacturers and pharmacy benefit managers received a holiday gift from President Trump on Friday: They still will not have to publicly post the actual prices of prescription drugs, more than five years after federal law required them to do so.
    • “Net drug prices — the amounts that health insurance companies and PBMs pay to drugmakers, after factoring in rebates — are highly valuable data that undergird the entire economic foundation of the U.S. pharmaceutical industry. But the decision from the Trump administration, rolled out in a new proposed rule, means that drug pricing data will likely remain locked out of public view for the foreseeable future.”
  • Avalere Health shares its perspective about December 2025 Advisory Committee on Immunization Practices Insights and 2026 Emerging Priorities.
    • “The ACIP’s December meeting resulted in a key change to the pediatric immunization schedule and signaled several potential changes to US vaccine coverage and access in 2026.”
  • Per an HHS news release,
    • “Executing on President Trump’s Executive Order (EO) 14192 titled “Unleashing Prosperity through Deregulation” and the President’s mandate to ensure the United States’ continued leadership in artificial intelligence (AI), the U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), today released the Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity (HTI-5) Proposed Rule.
    • “Today’s HTI-5 Proposed Rule has three core goals: (1) reducing burden on health IT developers by streamlining ASTP/ONC’s voluntary Health IT Certification Program by removing redundant requirements; (2) updating the information blocking regulations to better promote electronic health information access, exchange, and use so that patients’ access to their data is not blocked; and (3) advancing a new foundation of Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces (APIs) that promote AI-enabled interoperability solutions through modernized standards and certification. The HTI-5 proposed rule is expected to save $1.53 billion in total, including $650 million over the next five years for health IT developers, providers, and other stakeholders.
    • “The HTI-5 proposed rule delivers on President Trump’s directive to reduce regulatory burden and to enable American innovation through artificial intelligence,” said Tom Keane, MD, Assistant Secretary for Technology Policy and National Coordinator for Health IT. “These proposals reflect a commonsense approach that removes redundant requirements on health IT developers, that better ensures seamless patient access to their information and that sets a foundation for AI-based data exchange.” * * *
    • “More information can be found at healthit.gov/hti5 and via ASTP/ONC’s X account, @HHS_TechPolicy
    • “ASTP/ONC is also withdrawing certain proposals not yet finalized from the HTI-2 proposed rule.”

From the Food and Drug Administration front,

  • The Wall Street Journal reports,
    • “U.S. regulators approved the first GLP-1 weight-loss pill—a tablet formulation of Novo Nordisk’s NOVO.B  Ozempic and Wegovy—ushering in a new era of the obesity-drugs revolution that is expected to broaden their use.
    • “Novo Nordisk said it plans to start selling the new pill in the U.S. soon after the new year, with a cash price of $149 a month for the starting dose.
    • “The Food and Drug Administration approval is a milestone because weekly shots such as Wegovy and Eli Lilly’s LLY Zepbound have dominated the anti-obesity market to date. Yet many people with excess weight don’t take the shots due to cost, spotty insurance coverage and fear of needles.
    • “Drug companies and analysts say pills will tap in to demand from people who don’t want an injection or would prefer the cadence of a daily dose. Pills also offer the prospect of lower prices and better health-insurance coverage than injections, because pills cost less to make.
    • “Eli Lilly also plans to introduce a new weight-loss pill, potentially within weeks or months.” 
  • Fierce Pharma tells us,
    • “Just two months after reviving its prowess in the idiopathic pulmonary fibrosis (IPF) treatment area with rare lung disease med Jascayd, Boehringer Ingelheim is already unlocking another patient population with a new FDA nod.
    • “The new approval for Jascayd in progressive pulmonary fibrosis (PPF) makes the drug the only preferential phosphodiesterase 4B (PDE4B) inhibitor with immunomodulatory and antifibrotic effects approved in this indication, according to a Dec. 19 company press release.
    • “Progressive pulmonary fibrosis is a life-threatening condition with a high unmet medical need. The U.S. approval of Jascayd is an important step forward to help slow lung function decline for people living with PPF, providing a new, well-tolerated treatment option,” Boehringer’s head of human pharma, Shashank Deshpande, said in a release.”
  • MedTech Dive notes,
    • “Abbott said Monday that it has received Food and Drug Administration approval for its Volt pulsed field ablation system.
    • “The catheter-based device uses targeted, high-energy electrical pulses to treat a common heart arrhythmia called atrial fibrillation. Abbott’s Volt device is indicated for both paroxysmal AFib, where episodes come and go, and persistent AFib, or episodes that last longer than seven days, according to the FDA.
    • “Medtronic, Boston Scientific and Johnson & Johnson have all debuted their own PFA devices in the last two years. The approval allows Abbott to join the fast-growing, competitive market in the U.S.”

From the public health and medical / Rx research front,

  • The American Medical Association lets us know “What doctors wish patients knew about family immunizations.”
    • “Vaccines save millions of lives each year. Two infectious diseases physicians discuss the key role they should play for the loved ones in your family.”
  • Health Day informs us,
    • “Psychiatric conditions as varied as schizophrenia and bipolar disorder might be driven by very similar genetic underpinnings, a new study says. 
    • “Mental health problems can be sorted into five general genetic categories, each with a shared “genetic architecture” driving people’s illness, according to results published in the journal Nature.
    • “Right now, we diagnose psychiatric disorders based on what we see in the room, and many people will be diagnosed with multiple disorders. That can be hard to treat and disheartening for patients,” lead researcher Andrew Grotzinger, an assistant professor of psychology and neuroscience at the University of Colorado-Boulder, said in a news release.
    • “This work provides the best evidence yet that there may be things that we are currently giving different names to that are actually driven by the same biological processes,” he said.”
  • and
    • “A new risk score can help predict which pancreatic cancer survivors are more likely to suffer a recurrence of their cancer, researchers said.
    • “The score could help better manage the follow-up care for patients who’ve had pancreatic tumors surgically removed, and whose cancers have not spread to their lymph nodes, researchers wrote Dec. 17 in JAMA Surgery.
    • “We now have a way to identify patients whose higher risk of recurrence may have been previously overlooked,” senior researcher Dr. Cristina Ferrone, chair of surgery at Cedars-Sinai Medical Center in Los Angeles, said in a news release. “This gives us the opportunity to change the way we care for this patient population in a meaningful way.”
    • “The score helps people with pancreatic neuroendocrine tumors, which are a less common and typically less aggressive form of pancreatic cancer.
    • “Patients whose cancer has not spread outside the pancreas, to either the lymph nodes or surrounding organs, have a 91% five-year survival rate following surgery, researchers said in background notes.”
  • The Wall Street Journal relates
    • “For years, Barbara Schmidt’s family feared an illness was behind a pattern of terrifying falls that repeatedly landed the 83-year-old great-grandmother in surgery with broken bones. Instead, Schmidt’s frequent tumbles might have been tied to something else: medications intended to make her better.
    • “Schmidt, who lives with her husband of 65 years in Lewes, Del., filled prescriptions for more than a dozen different drugs in the past year, according to pharmacy and medical records.
    • “That isn’t unusual for America’s seniors, according to a Wall Street Journal analysis of Medicare data. One in six of the 46 million seniors enrolled in Medicare’s drug benefit, which pays for most drugs taken by older Americans, were prescribed eight or more medications.”
    • * * * “Schmidt’s recent prescriptions came from at least five different healthcare providers. Most were affiliated with the nearby hospital system Beebe Healthcare, including a nurse practitioner whom she sees for primary care and a gastroenterology office. An orthopedic surgeon who has treated her back problems and prescribed medications to help with her pain works for an independent practice, First State Orthopaedics. 
    • “A Beebe spokesman said it has reviewed its prescribing patterns and, this November, added a new electronic medical record that will allow doctors to “view consolidated medical and medication histories” for patients and deliver “safer, more informed care.” First State Orthopaedics said it doesn’t comment on matters of patient care unless it is legally required to do so.
    • “Pharmacists who work with seniors say doctors might not be aware of their patients’ full medication list. Patients don’t always mention what their other doctors have prescribed when a history is taken, and specialists might not have access to a shared medical record.
    • “The Journal analysis found that, among seniors taking eight or more drugs, it was common for the prescriptions to come from a large number of doctors.”

From the U.S. healthcare and artificial intelligence front,

  • Per Beckers Hospital Review,
    • “Houston-based Nutex Health has opened its 26th micro-hospital, Archview ER & Hospital, in St. Louis.
    • “The 16,000-square-foot facility includes 15 emergency room beds, three inpatient suites, a full-service laboratory and advanced imaging technology, according to a Dec. 22 Nutex Health news release.
    • “It replaces Homer G. Phillips Memorial Hospital, which surrendered its license and closed in March. The hospital had been temporarily closed since December 2024, when its license was suspended due to a blood supply shortage.”
  • and
    • “Mark Cuban Cost Plus Drug Co. has added Vegzelma, a biosimilar indicated for six cancer types, to its marketplace for hospitals and other healthcare providers. 
    • “The company plans to expand its biosimilar offerings amid growing demand for biologics among health systems, according to a news release shared with Becker’s. Cost Plus Drugs also offers Starjemza, a biosimilar to Johnson & Johnson’s Stelara (ustekinumab), at a price about $3,000 lower than retail at other pharmacies.
    • “Vegzelma is a biosimilar to Roche’s Avastin (bevacizumab), which is approved for treatment of metastatic colorectal cancer; non-squamous non-small cell lung cancer; recurrent glioblastoma; metastatic renal cell carcinoma; persistent, recurrent or metastatic cervical cancer; and epithelial ovarian, fallopian tube or primary peritoneal cancer.”